| Lafayette Street Dental Clinic | |
|
2700 South Lafayette Street Fort Wayne IN 46806 | |
| (260) 744-1188 | |
| Not Available |
| Full Name | Lafayette Street Dental Clinic |
|---|---|
| Speciality | Dentist |
| Location | 2700 South Lafayette Street, Fort Wayne, Indiana |
| Authorized Official Name and Position | Joan M Vaughan (DIRECTOR HIPAA PRIVACY COMPLIANCE) |
| Authorized Official Contact | 7654961927 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lafayette Street Dental Clinic 601 Stadium Mall Drive West Lafayette IN 47907-2052 Ph: (765) 496-1927 | Lafayette Street Dental Clinic 2700 South Lafayette Street Fort Wayne IN 46806 Ph: (260) 744-1188 |
| NPI Number | 1326249376 |
|---|---|
| Provider Enumeration Date | 05/29/2007 |
| Last Update Date | 07/23/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326249376 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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