# PURDUE UNIVERSITY

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

## Provider details

- **NPI number:** 1326249376
- **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:** 2700 SOUTH LAFAYETTE STREET, FORT WAYNE, IN 46806
- **Practice address phone:** (260) 744-1188
- **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:** 07/23/2008