NPIMap

Organization Active NPI

Purdue University

Doing business as IPFW Dental Hygiene Clinic

  • Dentist
  • Fort Wayne, IN
National Provider Identifier
1053512004
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
PURDUE UNIVERSITY
Doing business as
IPFW Dental Hygiene Clinic
Practice address
2101 East Coliseum Boulevard
Neff Hall Room 109
Fort Wayne, IN 46805-1499
Phone
(260) 481-6575
Fax
(260) 481-4162
NPI assigned
May 29, 2007
Last updated
Aug 2, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
PURDUE UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Joan M Vaughan
Title
Director Hipaa Privacy Compliance
Phone
(765) 496-1927

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

2101 East Coliseum Boulevard
Neff Hall Room 109
Fort Wayne, IN 46805-1499

Mailing address

601 Stadium Mall Drive
West Lafayette, IN 47907-2052
Phone (765) 496-1927

Other names 1

  • IPFW Dental Hygiene Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Purdue University Student19 organizations share this tax ID, including this one
Part of
Purdue University Student

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Locations

2101 E Coliseum Blvd
Rm 109
Fort Wayne, IN 46805
Phone (260) 481-6575

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659398400000",
    "number": "1053512004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 STADIUM MALL DRIVE",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "479072052",
            "telephone_number": "765-496-1927",
            "fax_number": "765-496-1227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 EAST COLISEUM BOULEVARD",
            "address_2": "NEFF HALL ROOM 109",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468051499",
            "telephone_number": "260-481-6575",
            "fax_number": "260-481-4162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURDUE UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PURDUE UNIVERSITY",
        "enumeration_date": "2007-05-29",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A",
        "authorized_official_last_name": "VAUGHAN",
        "authorized_official_first_name": "JOAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR HIPAA PRIVACY COMPLIANCE",
        "authorized_official_telephone_number": "765-496-1927",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IPFW Dental Hygiene Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.