| Periodontic Specialists, P.c. | |
|
7750 W Jefferson Blvd Fort Wayne IN 46804-4174 | |
| (260) 432-0577 | |
| (206) 432-0578 |
| Full Name | Periodontic Specialists, P.c. |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 7750 W Jefferson Blvd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Leah Gabrek (OPERATING SECRETARY) |
| Authorized Official Contact | 2604320577 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Periodontic Specialists, P.c. 7750 W Jefferson Blvd Fort Wayne IN 46804-4174 Ph: (260) 432-0577 | Periodontic Specialists, P.c. 7750 W Jefferson Blvd Fort Wayne IN 46804-4174 Ph: (260) 432-0577 |
| NPI Number | 1447410501 |
|---|---|
| Provider Enumeration Date | 06/12/2008 |
| Last Update Date | 06/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447410501 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | (* (Not Available)) | Primary |
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