Individual
DR. BRETT MICHAEL DISALLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 460-1353
(260) 460-1308
Mailing address
430 AUGUSTA WAY, FORT WAYNE, IN 46825-2175
(260) 497-9615
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009812
IN
Other
Enumeration date
10/05/2006
Last updated
07/08/2007
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