Organization
DOCTOR EADY FAMILY DENTISTRY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARVIN PRESTON EADY JR. DDS (PRESIDENT)
(260) 459-1415
Entity
Organization
Contact information
Practice address
4646 W JEFFERSON BLVD, SUITE 140, FORT WAYNE, IN 46804-6842
(260) 459-1415
(260) 459-1419
Mailing address
4646 W JEFFERSON BLVD, SUITE 140, FORT WAYNE, IN 46804-6842
(260) 459-1415
(260) 459-1419
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009115
IN
Other
Enumeration date
02/17/2017
Last updated
02/17/2017
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