# HALE FAMILY DENTISTRY CORP

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

## Provider details

- **NPI number:** 1912569492
- **Authorized official:** CASSANDRA HALE (MANAGER)
- **Authorized official phone:** (260) 482-3759

## Contact information

- **Practice address:** 4116 E STATE BLVD, FORT WAYNE, IN 46815-6977
- **Practice address phone:** (260) 482-3759
- **Practice address fax:** (260) 846-6641
- **Mailing address:** 4116 E STATE BLVD, FORT WAYNE, IN 46815-6977
- **Mailing address phone:** (260) 482-3759
- **Mailing address fax:** (260) 482-3750

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |
| 332BC3200X | Customized Equipment (DME) | — | — | — |

## Other

- **Enumeration date:** 07/03/2019
- **Last updated:** 05/01/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 300067224 | — | IN |