| Fort Wayne Oral Maxillofacial Surgery & Implant Center, Llc | |
|
2121 E Dupont Rd Suite #c Fort Wayne IN 46825-1546 | |
| (260) 490-2013 | |
| (260) 490-1081 |
| Full Name | Fort Wayne Oral Maxillofacial Surgery & Implant Center, Llc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 2121 E Dupont Rd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Mulokozi K. Lugakingira (PRESIDENT) |
| Authorized Official Contact | 2604902013 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fort Wayne Oral Maxillofacial Surgery & Implant Center, Llc 2121 E Dupont Rd Suite #c Fort Wayne IN 46825-1546 Ph: (260) 490-2013 | Fort Wayne Oral Maxillofacial Surgery & Implant Center, Llc 2121 E Dupont Rd Suite #c Fort Wayne IN 46825-1546 Ph: (260) 490-2013 |
| NPI Number | 1649347832 |
|---|---|
| Provider Enumeration Date | 11/30/2006 |
| Last Update Date | 10/07/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649347832 | NPI | - | NPPES |
| 201036240 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (Indiana) | Primary |
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