| Fort Wayne Prosthodontics, Inc. | |
|
4205 Hobson Ct Fort Wayne IN 46815-8648 | |
| (260) 486-8778 | |
| Not Available |
| Full Name | Fort Wayne Prosthodontics, Inc. |
|---|---|
| Speciality | Dentist |
| Location | 4205 Hobson Ct, Fort Wayne, Indiana |
| Authorized Official Name and Position | Kellie Jae Brower (OFFICE MANAGER) |
| Authorized Official Contact | 2604868778 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fort Wayne Prosthodontics, Inc. 4205 Hobson Ct Fort Wayne IN 46815-8648 Ph: (260) 486-8778 | Fort Wayne Prosthodontics, Inc. 4205 Hobson Ct Fort Wayne IN 46815-8648 Ph: (260) 486-8778 |
| NPI Number | 1447713219 |
|---|---|
| Provider Enumeration Date | 04/09/2019 |
| Last Update Date | 09/10/2020 |
| Medicare PECOS PAC ID | 3870823354 |
|---|---|
| Medicare Enrollment ID | O20190926000087 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447713219 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0700X | Dentist - Prosthodontics | (* (Not Available)) | Primary |
| Provider Name | Ryan D Zimmerman |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1467773911 PECOS PAC ID: 0941548408 Enrollment ID: I20190208001758 |
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