Organization
NORTHEAST INDIANA ORTHODONTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALLISON BERGDOLL DDS, MS (PRESIDENT, ORTHODONTIST)
(260) 338-2643
Entity
Organization
Contact information
Practice address
2121 E DUPONT RD STE D, FORT WAYNE, IN 46825-1546
(260) 338-2643
Mailing address
2121 E DUPONT RD STE D, FORT WAYNE, IN 46825-1546
(260) 338-2643
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
12/12/2024
Last updated
12/12/2024
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