# PURDUE UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PURDUE UNIVERSITY
- **Other names:** IPFW Dental Hygiene Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1053512004
- **Legal business name:** PURDUE UNIVERSITY
- **Authorized official:** MS. JOAN M VAUGHAN (DIRECTOR HIPAA PRIVACY COMPLIANCE)
- **Authorized official phone:** (765) 496-1927

## Contact information

- **Practice address:** 2101 EAST COLISEUM BOULEVARD, NEFF HALL ROOM 109, FORT WAYNE, IN 46805-1499
- **Practice address phone:** (260) 481-6575
- **Practice address fax:** (260) 481-4162
- **Mailing address:** 601 STADIUM MALL DRIVE, WEST LAFAYETTE, IN 47907-2052
- **Mailing address phone:** (765) 496-1927
- **Mailing address fax:** (765) 496-1227

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 05/29/2007
- **Last updated:** 08/02/2022