Organization
FORT WAYNE DENTAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT E MUTTON DDS (OWNER)
(260) 432-3459
Entity
Organization
Contact information
Practice address
7202 ENGLE RD, FORT WAYNE, IN 46804-2222
(260) 432-3459
(260) 436-4757
Mailing address
7202 ENGLE RD, FORT WAYNE, IN 46804-2222
(260) 432-3459
(260) 436-4757
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
12008127
IN
1223G0001X
General Practice Dentistry
Primary
12010298A
IN
1223P0221X
Pediatric Dentistry
12009199
IN
Other
Enumeration date
12/06/2006
Last updated
09/11/2025
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