Indiana Pediatric Dental & Anesthesia LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

INDIANA PEDIATRIC DENTAL & ANESTHESIA LLC

Practice address

3030 Lake Ave Ste 15
Fort Wayne, IN 46805-5428

Phone

(512) 902-9997

NPI assigned

Feb 21, 2021

Last updated

Feb 21, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lucian Dan Boboia, DDSNPI 1215004783

Title

Owner

Phone

(512) 902-9997

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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.

• Lucian Dan Boboia, DDS

  • Dental Anesthesiology
  • Fort Wayne, IN
  • NPI 1215004783
  Authorized official Same address or phone

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

{
    "created_epoch": "1613865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613865600000",
    "number": "1164016127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 LAKE AVE STE 15",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055428",
            "telephone_number": "512-902-9997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 LAKE AVE STE 15",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055428",
            "telephone_number": "512-902-9997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA PEDIATRIC DENTAL & ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-21",
        "last_updated": "2021-02-21",
        "certification_date": "2021-02-21",
        "status": "A",
        "authorized_official_last_name": "BOBOIA",
        "authorized_official_first_name": "LUCIAN",
        "authorized_official_middle_name": "DAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-902-9997",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF INDIANA DENTISTRY BOARD",
            "identifier": "12010910A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Indiana Health & Rehabilitation Center (Glenbrook Rehabilitation & Skilled Nursing Center)
• Indiana Health and Rehabilitation Centers (Canterbury Gardens)
• Indiana Health and Rehabilitation Centers (Canterbury Nursing and Rehabilitation Center)
• Indiana Medical Associates, LLC
• Indiana Pathology Consultants, Inc.
• Indiana Physical Therapy Inc
• Indiana Physical Therapy, Inc
• Indiana Plastic Surgery Center, PC
• Indiana Professional Psychological Services, P.C.
• Indiana Psychiatric Associates LLC (Indiana TMS)

• 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 Feb 21, 2021; 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.