# FAMILY DENTISTRY & AESTHETIC INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Thomas T Teel Thomas M Gilbert & Catherine N Periolat
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457462590
- **Authorized official:** DR. THOMAS T TEEL DDS (OWNER PRESIDENT)
- **Authorized official phone:** (260) 432-0561

## Contact information

- **Practice address:** 4626 WEST JEFFERSON BLVD, FORT WAYNE, IN 46804
- **Practice address phone:** (260) 432-0561
- **Practice address fax:** (260) 436-4626
- **Mailing address:** 4626 WEST JEFFERSON BLVD, FORT WAYNE, IN 46804
- **Mailing address phone:** (260) 432-0561
- **Mailing address fax:** (260) 436-4626

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12009882 | IN | Yes |
| 1223G0001X | General Practice Dentistry | 9047 | IN | — |
| 1223G0001X | General Practice Dentistry | 9757 | IN | — |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 08/22/2020