| Doctor Eady Family Dentistry, P.c. | |
|
4646 W Jefferson Blvd Suite 140 Fort Wayne IN 46804-6842 | |
| (260) 459-1415 | |
| (260) 459-1419 |
| Full Name | Doctor Eady Family Dentistry, P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4646 W Jefferson Blvd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Marvin Preston Eady (PRESIDENT) |
| Authorized Official Contact | 2604591415 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Doctor Eady Family Dentistry, P.c. 4646 W Jefferson Blvd Suite 140 Fort Wayne IN 46804-6842 Ph: (260) 459-1415 | Doctor Eady Family Dentistry, P.c. 4646 W Jefferson Blvd Suite 140 Fort Wayne IN 46804-6842 Ph: (260) 459-1415 |
| NPI Number | 1548709900 |
|---|---|
| Provider Enumeration Date | 02/17/2017 |
| Last Update Date | 02/17/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548709900 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 12009115 (Indiana) | Primary |
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