| Indiana Pediatric Dental & Anesthesia Llc | |
|
3030 Lake Ave Ste 15 Fort Wayne IN 46805-5428 | |
| (512) 902-9997 | |
| Not Available |
| Full Name | Indiana Pediatric Dental & Anesthesia Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 3030 Lake Ave Ste 15, Fort Wayne, Indiana |
| Authorized Official Name and Position | Lucian Dan Boboia (OWNER) |
| Authorized Official Contact | 5129029997 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Indiana Pediatric Dental & Anesthesia Llc 3030 Lake Ave Ste 15 Fort Wayne IN 46805-5428 Ph: (512) 902-9997 | Indiana Pediatric Dental & Anesthesia Llc 3030 Lake Ave Ste 15 Fort Wayne IN 46805-5428 Ph: (512) 902-9997 |
| NPI Number | 1164016127 |
|---|---|
| Provider Enumeration Date | 02/21/2021 |
| Last Update Date | 02/21/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164016127 | NPI | - | NPPES |
| 12010910A | Other | IN | STATE OF INDIANA DENTISTRY BOARD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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