Organization
FORT WAYNE ORAL MAXILLOFACIAL SURGERY & IMPLANT CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MULOKOZI K. LUGAKINGIRA DMD, MS, DDS (PRESIDENT)
(260) 490-2013
Entity
Organization
Contact information
Practice address
2121 E DUPONT RD, SUITE #C, FORT WAYNE, IN 46825-1546
(260) 490-2013
(260) 490-1081
Mailing address
2121 E DUPONT RD, SUITE #C, FORT WAYNE, IN 46825-1546
(260) 490-2013
(260) 490-1081
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201036240
—
IN
Enumeration date
11/30/2006
Last updated
10/07/2013
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