Orchard Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ORCHARD DENTAL LLC

Practice address

4716 Illinois Rd Ste 101
Fort Wayne, IN 46804-5123

Phone

(260) 432-7970

NPI assigned

Oct 5, 2026

Last updated

Oct 5, 2026By 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

Marianne Tilton

Title

Provider Enrollment Supervisor

Phone

(315) 454-6000

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1791158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791158400000",
    "number": "1205730215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70887",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441900887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4716 ILLINOIS RD STE 101",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468045123",
            "telephone_number": "260-432-7970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORCHARD DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-05",
        "last_updated": "2026-10-05",
        "certification_date": "2026-10-05",
        "status": "A",
        "authorized_official_last_name": "TILTON",
        "authorized_official_first_name": "MARIANNE",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT SUPERVISOR",
        "authorized_official_telephone_number": "315-454-6000"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.