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Indiana Pediatric Dental & Anesthesia Llc
Pediatric Dentist in Fort Wayne, Indiana
NPI 1164016127

Indiana Pediatric Dental & Anesthesia Llc is a Pediatric Dentist based in Fort Wayne, IN and is specialized in Pediatric Dentistry. Indiana Pediatric Dental & Anesthesia Llc practices in Fort Wayne, IN. The NPI Number for Indiana Pediatric Dental & Anesthesia Llc is 1164016127 and holds a License No. (Indiana).

The current practice location address for Indiana Pediatric Dental & Anesthesia Llc is 3030 Lake Ave Ste 15, Fort Wayne, IN and can be reached out via phone at 512-902-9997.

Location: 3030 Lake Ave Ste 15, Fort Wayne, IN, 46805-5428
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1164016127
Provider Name
Indiana Pediatric Dental & Anesthesia Llc
Credential
Provider Entity Type
Organization
Address
3030 Lake Ave Ste 15, Fort Wayne, IN, 46805-5428
Phone Number
512-902-9997
Fax Number
Provider Enumeration Date
02/21/2021
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
12010910A 01 IN STATE OF INDIANA DENTISTRY BOARD
institution
Provider Business Practice Location Address Details
Address
3030 Lake Ave Ste 15
City
Fort Wayne
State
Indiana
Zip
46805-5428
Phone Number
512-902-9997
Fax Number
person
Provider Business Mailing Address Details
Address
3030 Lake Ave Ste 15
City
Fort Wayne
State
Indiana
Zip
46805-5428
Phone Number
512-902-9997
Fax Number
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
1223P0221X
License No.
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Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
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