Purdue University
Organization Active NPI Dentist · Fort Wayne, IN
NPI 1326249376 · NPPES record last updated Jul 23, 2008
Key facts
- NPI
- 1326249376
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- Legal business name
- PURDUE UNIVERSITY
- Practice address
- 2700 South Lafayette Street
Fort Wayne, IN 46806 - Phone
- (260) 744-1188
- NPI assigned
- May 29, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- PURDUE UNIVERSITY
Authorized official
- Name
- Ms. Joan M Vaughan
- Title
- Director Hipaa Privacy Compliance
- Phone
- (765) 496-1927
Corporate family (same tax ID) 18
National Provider Directory
- Tax ID family
- Purdue University Sports Medicine West Lafayette
- Part of
- Purdue University Sports Medicine West Lafayette
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | Yes |
Addresses
Primary practice location
2700 South Lafayette Street
Fort Wayne, IN 46806
Mailing address
601 Stadium Mall Drive
West Lafayette, IN 47907-2052
Phone (765) 496-1927
Other names
- Lafayette Street Dental Clinic
Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.