Marvin Preston Eady Jr., DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12009115A Issued in IN

Practice address

4646 W Jefferson Blvd
Suite 140
Fort Wayne, IN 46804-6842

Phone

(260) 459-1415

Fax

(260) 459-1419

NPI assigned

Jan 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Doctor Eady Family Dentistry, P.C.

  • General Practice Dentistry
  • Fort Wayne, IN
  • NPI 1548709900
  NPD (past) Authorized official

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1457331332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4646 W JEFFERSON BLVD",
            "address_2": "SUITE 140",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046842",
            "telephone_number": "260-459-1415",
            "fax_number": "260-459-1419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 W JEFFERSON BLVD",
            "address_2": "SUITE 140",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046842",
            "telephone_number": "260-459-1415",
            "fax_number": "260-459-1419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EADY",
        "first_name": "MARVIN",
        "middle_name": "PRESTON",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-18",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12009115A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.