Organization
PRIME DENTAL CARE LLC
Active
Other names
PRIME DENTAL
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIJAY KUMAR GODI DDS (DENTIST)
(419) 788-5803
Entity
Organization
Contact information
Practice address
435 W COLISEUM BLVD, FORT WAYNE, IN 46805-1010
(260) 263-6200
Mailing address
3210 TROUTWOOD DR, FORT WAYNE, IN 46818-8791
(419) 788-5803
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/18/2023
Last updated
09/18/2023
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