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Organization
DENTAL CONSULTS OF NORTHEAST INDIANA, PC
Active
Organization
DENTAL CONSULTS OF NORTHEAST INDIANA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW DAVID HALLER D.M.D. (PRESIDENT)
(260) 489-6544
Entity
Organization
Contact information
Practice address
11115 LIMA RD, FORT WAYNE, IN 46818-9536
(260) 489-6544
(260) 416-0544
Mailing address
11115 LIMA RD, FORT WAYNE, IN 46818-9536
(260) 489-6544
(260) 416-0544
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008792
IN
Other
Enumeration date
03/27/2007
Last updated
06/18/2008
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