Organization
FAMILY DENTISTRY & AESTHETIC INC
Active
Other names
Thomas T Teel Thomas M Gilbert & Catherine N Periolat
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS T TEEL DDS (OWNER PRESIDENT)
(260) 432-0561
Entity
Organization
Contact information
Practice address
4626 WEST JEFFERSON BLVD, FORT WAYNE, IN 46804
(260) 432-0561
(260) 436-4626
Mailing address
4626 WEST JEFFERSON BLVD, FORT WAYNE, IN 46804
(260) 432-0561
(260) 436-4626
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009882
IN
1223G0001X
General Practice Dentistry
9047
IN
1223G0001X
General Practice Dentistry
9757
IN
Other
Enumeration date
08/31/2006
Last updated
08/22/2020
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