Organization
PEDIATRIC DENTISTRY INC
Active
Other names
Wayne L Dawes DDS Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WAYNE LEE DAWES DDS (PRESIDENT OWNER)
(260) 459-0903
Entity
Organization
Contact information
Practice address
7750 WEST JEFFERSON BLVD, FORT WAYNE, IN 46804-4136
(260) 459-0903
(260) 459-0673
Mailing address
7750 WEST JEFFERSON BLVD, FORT WAYNE, IN 46804-4136
(260) 459-0903
(260) 459-0673
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
54000382A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104667
IND DEPT OF HEALTH CHILDR
IN
Enumeration date
07/08/2006
Last updated
08/22/2020
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