| Wayne Youth Dentistry, Llc | |
|
7524 S Anthony Blvd Fort Wayne IN 46816-2517 | |
| (260) 441-8500 | |
| (260) 441-0887 |
| Full Name | Wayne Youth Dentistry, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 7524 S Anthony Blvd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Jenell Stump (MANAGER, LICENSING & CREDENTIALING) |
| Authorized Official Contact | 6157500343 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wayne Youth Dentistry, Llc 16 Arcade Unit 198747 Nashville TN 37219-1994 Ph: (615) 750-0343 | Wayne Youth Dentistry, Llc 7524 S Anthony Blvd Fort Wayne IN 46816-2517 Ph: (260) 441-8500 |
| NPI Number | 1356399182 |
|---|---|
| Provider Enumeration Date | 05/04/2006 |
| Last Update Date | 07/09/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356399182 | NPI | - | NPPES |
| 2619223 | Medicaid | OH | |
| 200542880A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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