Organization
C CHASE ELLINWOOD DDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES CHASE ELILNWOOD DDS (MEMBER)
(260) 492-2640
Entity
Organization
Contact information
Practice address
5725 MAPLECREST RD STE 1, FORT WAYNE, IN 46835-4937
(260) 492-2640
Mailing address
5725 MAPLECREST RD STE 1, FORT WAYNE, IN 46835-4937
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/09/2024
Last updated
12/09/2024
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