| Ipfw Dental Hygiene Clinic | |
|
2101 East Coliseum Boulevard Neff Hall Room 109 Fort Wayne IN 46805-1499 | |
| (260) 481-6575 | |
| (260) 481-4162 |
| Full Name | Ipfw Dental Hygiene Clinic |
|---|---|
| Speciality | Dentist |
| Location | 2101 East Coliseum Boulevard, Fort Wayne, Indiana |
| Authorized Official Name and Position | Joan M Vaughan (DIRECTOR HIPAA PRIVACY COMPLIANCE) |
| Authorized Official Contact | 7654961927 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ipfw Dental Hygiene Clinic 601 Stadium Mall Drive West Lafayette IN 47907-2052 Ph: (765) 496-1927 | Ipfw Dental Hygiene Clinic 2101 East Coliseum Boulevard Neff Hall Room 109 Fort Wayne IN 46805-1499 Ph: (260) 481-6575 |
| NPI Number | 1053512004 |
|---|---|
| Provider Enumeration Date | 05/29/2007 |
| Last Update Date | 08/02/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053512004 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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