Organization
HALE FAMILY DENTISTRY CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASSANDRA HALE (MANAGER)
(260) 482-3759
Entity
Organization
Contact information
Practice address
4116 E STATE BLVD, FORT WAYNE, IN 46815-6977
(260) 482-3759
(260) 846-6641
Mailing address
4116 E STATE BLVD, FORT WAYNE, IN 46815-6977
(260) 482-3759
(260) 482-3750
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300067224
—
IN
Enumeration date
07/03/2019
Last updated
05/01/2023
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