# DENTAL CONSULTS OF NORTHEAST INDIANA, PC

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

## Provider details

- **NPI number:** 1568580470
- **Authorized official:** DR. MATTHEW DAVID HALLER D.M.D. (PRESIDENT)
- **Authorized official phone:** (260) 489-6544

## Contact information

- **Practice address:** 11115 LIMA RD, FORT WAYNE, IN 46818-9536
- **Practice address phone:** (260) 489-6544
- **Practice address fax:** (260) 416-0544
- **Mailing address:** 11115 LIMA RD, FORT WAYNE, IN 46818-9536
- **Mailing address phone:** (260) 489-6544
- **Mailing address fax:** (260) 416-0544

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12008792 | IN | Yes |

## Other

- **Enumeration date:** 03/27/2007
- **Last updated:** 06/18/2008