| Northeast Indiana Orthodontics, Llc | |
|
2121 E Dupont Rd Ste D Fort Wayne IN 46825-1546 | |
| (260) 338-2643 | |
| Not Available |
| Full Name | Northeast Indiana Orthodontics, Llc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 2121 E Dupont Rd Ste D, Fort Wayne, Indiana |
| Authorized Official Name and Position | Allison Bergdoll (PRESIDENT, ORTHODONTIST) |
| Authorized Official Contact | 2603382643 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeast Indiana Orthodontics, Llc 2121 E Dupont Rd Ste D Fort Wayne IN 46825-1546 Ph: (260) 338-2643 | Northeast Indiana Orthodontics, Llc 2121 E Dupont Rd Ste D Fort Wayne IN 46825-1546 Ph: (260) 338-2643 |
| NPI Number | 1982411088 |
|---|---|
| Provider Enumeration Date | 12/12/2024 |
| Last Update Date | 12/12/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982411088 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
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