Pediatric Dentistry Inc

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

54000382A Issued in IN

Legal business name

PEDIATRIC DENTISTRY INC

Practice address

7750 West Jefferson Blvd
Fort Wayne, IN 46804-4136

Phone

(260) 459-0903

Fax

(260) 459-0673

NPI assigned

Jul 8, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Wayne Lee Dawes, DDS

Title

President Owner

Phone

(260) 459-0903

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wayne L Dawes DDS Inc Former legal business name

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104859701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7750 WEST JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044136",
            "telephone_number": "260-459-0903",
            "fax_number": "260-459-0673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7750 WEST JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044136",
            "telephone_number": "260-459-0903",
            "fax_number": "260-459-0673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAWES",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "260-459-0903",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IN",
            "license": "54000382A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IND DEPT OF HEALTH CHILDR",
            "identifier": "104667",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wayne L Dawes DDS Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Pediatric Dentistry in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Pediatric Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.