# LIFETIME DENTAL CARE OF INDIANA, PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LIFETIME DENTAL CARE OF INDIANA, PC
- **Other names:** Dental Design of Fort Wayne
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1336361740
- **Legal business name:** LIFETIME DENTAL CARE OF INDIANA, PC
- **Authorized official:** JENNIFER HOELSCHER (INS COOD)
- **Authorized official phone:** (217) 540-5100

## Contact information

- **Practice address:** 2828 E STATE BLVD, FORT WAYNE, IN 46805-4761
- **Practice address phone:** (260) 482-6689
- **Practice address fax:** (260) 482-6948
- **Mailing address:** 2828 E STATE BLVD, FORT WAYNE, IN 46805-4761
- **Mailing address phone:** (260) 482-6689
- **Mailing address fax:** (260) 482-6948

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 05/03/2007
- **Last updated:** 11/01/2014