Organization
PURDUE UNIVERSITY
Active
Parent organization
PURDUE UNIVERSITY
Other names
Lafayette Street Dental Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
PURDUE UNIVERSITY
Authorized official
MS. JOAN M VAUGHAN (DIRECTOR HIPAA PRIVACY COMPLIANCE)
(765) 496-1927
Entity
Organization
Contact information
Practice address
2700 SOUTH LAFAYETTE STREET, FORT WAYNE, IN 46806
(260) 744-1188
Mailing address
601 STADIUM MALL DRIVE, WEST LAFAYETTE, IN 47907-2052
(765) 496-1927
(765) 496-1227
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
05/29/2007
Last updated
07/23/2008
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