# FORT WAYNE DENTAL GROUP, LLC

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

## Provider details

- **NPI number:** 1922167188
- **Authorized official:** DR. BRENT E MUTTON DDS (OWNER)
- **Authorized official phone:** (260) 432-3459

## Contact information

- **Practice address:** 7202 ENGLE RD, FORT WAYNE, IN 46804-2222
- **Practice address phone:** (260) 432-3459
- **Practice address fax:** (260) 436-4757
- **Mailing address:** 7202 ENGLE RD, FORT WAYNE, IN 46804-2222
- **Mailing address phone:** (260) 432-3459
- **Mailing address fax:** (260) 436-4757

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12008127 | IN | — |
| 1223G0001X | General Practice Dentistry | 12010298A | IN | Yes |
| 1223P0221X | Pediatric Dentistry | 12009199 | IN | — |

## Other

- **Enumeration date:** 12/06/2006
- **Last updated:** 09/11/2025