Organization
DENTAL CONSULTS OF NORTHEAST INDIANA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW DAVID HALLER D.M.D. (PRESIDENT)
(260) 489-6544
Entity
Organization
Contact information
Practice address
11115 LIMA RD, FORT WAYNE, IN 46818-9536
(260) 489-6544
(260) 416-0544
Mailing address
11115 LIMA RD, FORT WAYNE, IN 46818-9536
(260) 489-6544
(260) 416-0544
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008792
IN
Other
Enumeration date
03/27/2007
Last updated
06/18/2008
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