NPIMap

Organization Active NPI

Fort Wayne Endodontics

  • Endodontics
  • Fort Wayne, IN
National Provider Identifier
1083265433
Registry record updated Sep 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
Legal business name
FORT WAYNE ENDODONTICS
Practice address
9407 Illinois Rd
Fort Wayne, IN 46804
Phone
(260) 436-5772
Fax
(260) 436-5779
NPI assigned
Sep 26, 2019
Last updated
Sep 26, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2019

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

Authorized official

Name
Dr. Jason P Glassley, DDS, MSDNPI 1679735898
Title
President
Phone
(260) 436-5772

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X Primary

Addresses

Primary practice location

9407 Illinois Rd
Fort Wayne, IN 46804

Mailing address

9407 Illinois Rd
Fort Wayne, IN 46804
Phone (260) 436-5772

National Provider Directory

National Provider Directory

Locations

9407 Illinois Rd
Fort Wayne, IN 46804
Phone (260) 436-5772

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1569456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569456000000",
    "number": "1083265433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9407 ILLINOIS RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46804",
            "telephone_number": "260-436-5772",
            "fax_number": "260-436-5779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9407 ILLINOIS RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46804",
            "telephone_number": "260-436-5772",
            "fax_number": "260-436-5779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WAYNE ENDODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-26",
        "last_updated": "2019-09-26",
        "status": "A",
        "authorized_official_last_name": "GLASSLEY",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-436-5772",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MSD"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Sep 26, 2019; 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.