| Hale Family Dentistry Corp | |
|
4116 E State Blvd Fort Wayne IN 46815-6977 | |
| (260) 482-3759 | |
| (260) 846-6641 |
| Full Name | Hale Family Dentistry Corp |
|---|---|
| Speciality | Dentist |
| Location | 4116 E State Blvd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Cassandra Hale (MANAGER) |
| Authorized Official Contact | 2604823759 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hale Family Dentistry Corp 4116 E State Blvd Fort Wayne IN 46815-6977 Ph: (260) 482-3759 | Hale Family Dentistry Corp 4116 E State Blvd Fort Wayne IN 46815-6977 Ph: (260) 482-3759 |
| NPI Number | 1912569492 |
|---|---|
| Provider Enumeration Date | 07/03/2019 |
| Last Update Date | 05/01/2023 |
| Medicare PECOS PAC ID | 5890102735 |
|---|---|
| Medicare Enrollment ID | O20210322001049 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912569492 | NPI | - | NPPES |
| 300067224 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
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