Organization
MIDTOWN DENTAL P C
Active
Other names
Shambaugh Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA RUTHERFORD (OFFICE MANAGER)
(260) 432-8596
Entity
Organization
Contact information
Practice address
4616 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6826
(260) 432-8596
Mailing address
4616 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6826
(260) 432-8596
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/24/2015
Last updated
05/02/2016
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