Organization
FORT WAYNE FAMILY DENTISTRY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OPAL ANDERSON (MANAGER)
(440) 823-6790
Entity
Organization
Contact information
Practice address
6126 TRIER RD, FORT WAYNE, IN 46815-5339
(440) 823-6790
Mailing address
33300 WARREN RD STE 29, WESTLAND, MI 48185-9627
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/22/2022
Last updated
04/22/2022
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