Wayne Youth Dentistry, LLC
NPI #1356399182 in Fort Wayne, Indiana
Provider Information
- NPI Number
- 1356399182
- Entity Type
- Organization
- Organization Name
- Wayne Youth Dentistry, LLC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- May 4, 2006
- Last Updated
- Jul 9, 2014
Practice Location
- Address
- 7524 S ANTHONY BLVD
- City
- Fort Wayne
- State
- Indiana
- ZIP Code
- 46816-2517
- Phone
- (260) 441-8500
Authorized Official
- Name
- MRS. JENELL STUMP
- Title
- MANAGER, LICENSING & CREDENTIALING
- Phone
- (615) 750-0343
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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