Fort Wayne Pediatric Dentistry LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

12011802A Issued in IN

Legal business name

FORT WAYNE PEDIATRIC DENTISTRY LLC

Practice address

10211 Dupont Circle Dr W
Fort Wayne, IN 46825-1622

Phone

(260) 490-5437

NPI assigned

Oct 16, 2017

Organization subpart

No

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

Authorized official

Name

Kevin Ludwig, DDS

Title

Owner/Pediatric Dentist

Phone

(219) 929-6739

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Timothy R Olinger, DDS

  • Pediatric Dentistry
  • Fort Wayne, IN
  • NPI 1619059557
  NPD (past)

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

{
    "created_epoch": "1508112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508112000000",
    "number": "1689185886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "378 ELDERWOOD CT",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468454510",
            "telephone_number": "219-929-6739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10211 DUPONT CIRCLE DR W",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251622",
            "telephone_number": "260-490-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WAYNE PEDIATRIC DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-16",
        "last_updated": "2017-10-16",
        "status": "A",
        "authorized_official_last_name": "LUDWIG",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER/PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "219-929-6739",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IN",
            "license": "12011802A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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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 Oct 16, 2017; 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.