# FORT WAYNE ORAL MAXILLOFACIAL SURGERY & IMPLANT CENTER, LLC

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

## Provider details

- **NPI number:** 1649347832
- **Authorized official:** DR. MULOKOZI K. LUGAKINGIRA DMD, MS, DDS (PRESIDENT)
- **Authorized official phone:** (260) 490-2013

## Contact information

- **Practice address:** 2121 E DUPONT RD, SUITE \#C, FORT WAYNE, IN 46825-1546
- **Practice address phone:** (260) 490-2013
- **Practice address fax:** (260) 490-1081
- **Mailing address:** 2121 E DUPONT RD, SUITE \#C, FORT WAYNE, IN 46825-1546
- **Mailing address phone:** (260) 490-2013
- **Mailing address fax:** (260) 490-1081

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | IN | Yes |

## Other

- **Enumeration date:** 11/30/2006
- **Last updated:** 10/07/2013