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Organization
PERIODONTICS LIMITED
Active
Organization
PERIODONTICS LIMITED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LLOYD J. HAGEDORN DDS, MSD (SENIOR PARTNER)
(260) 432-0577
Entity
Organization
Contact information
Practice address
7750 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4174
(260) 432-0577
(260) 432-0578
Mailing address
7750 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4174
(260) 432-0577
(260) 432-0578
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
10/06/2006
Last updated
08/22/2020
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