# DOCTOR EADY FAMILY DENTISTRY, P.C.

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

## Provider details

- **NPI number:** 1548709900
- **Authorized official:** DR. MARVIN PRESTON EADY JR. DDS (PRESIDENT)
- **Authorized official phone:** (260) 459-1415

## Contact information

- **Practice address:** 4646 W JEFFERSON BLVD, SUITE 140, FORT WAYNE, IN 46804-6842
- **Practice address phone:** (260) 459-1415
- **Practice address fax:** (260) 459-1419
- **Mailing address:** 4646 W JEFFERSON BLVD, SUITE 140, FORT WAYNE, IN 46804-6842
- **Mailing address phone:** (260) 459-1415
- **Mailing address fax:** (260) 459-1419

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12009115 | IN | Yes |

## Other

- **Enumeration date:** 02/17/2017
- **Last updated:** 02/17/2017