# FORT WAYNE FAMILY DENTISTRY INC

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

## Provider details

- **NPI number:** 1629712054
- **Authorized official:** OPAL ANDERSON (MANAGER)
- **Authorized official phone:** (440) 823-6790

## Contact information

- **Practice address:** 6126 TRIER RD, FORT WAYNE, IN 46815-5339
- **Practice address phone:** (440) 823-6790
- **Mailing address:** 33300 WARREN RD STE 29, WESTLAND, MI 48185-9627

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 04/22/2022
- **Last updated:** 04/22/2022