# GEBFERT-PARK FAMILY DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518045574
- **Authorized official:** LAWRENCE PARK DDS (DENTIST)
- **Authorized official phone:** (260) 490-4440

## Contact information

- **Practice address:** 10010 DUPONT CIRCLE CT, FORT WAYNE, IN 46825-1626
- **Practice address phone:** (260) 490-4440
- **Mailing address:** 10010 DUPONT CIRCLE CT, FORT WAYNE, IN 46825-1626

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12010099B | IN | Yes |

## Other

- **Enumeration date:** 11/01/2006
- **Last updated:** 08/22/2020