NPIMap

Organization Active NPI

Fort Wayne Dental Group, LLC

  • General Practice Dentistry
  • Fort Wayne, IN
National Provider Identifier
1922167188
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12010298A Issued in IN
Legal business name
FORT WAYNE DENTAL GROUP, LLC
Practice address
7202 Engle Rd
Fort Wayne, IN 46804-2222
Phone
(260) 432-3459
Fax
(260) 436-4757
NPI assigned
Dec 6, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Dr. Brent E Mutton, DDSNPI 1427273390
Title
Owner
Phone
(260) 432-3459

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 12008127 IN
General Practice Dentistry 1223G0001X 12010298A IN Primary
Pediatric Dentistry 1223P0221X 12009199 IN

Addresses

Primary practice location

7202 Engle Rd
Fort Wayne, IN 46804-2222

Mailing address

7202 Engle Rd
Fort Wayne, IN 46804-2222
Phone (260) 432-3459

National Provider Directory

National Provider Directory

Locations

7202 Engle Rd
Fort Wayne, IN 46804
Phone (260) 432-3459

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1922167188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7202 ENGLE RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042222",
            "telephone_number": "260-432-3459",
            "fax_number": "260-436-4757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7202 ENGLE RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042222",
            "telephone_number": "260-432-3459",
            "fax_number": "260-436-4757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WAYNE DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "MUTTON",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-432-3459",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12008127",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010298A",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IN",
            "license": "12009199",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.