Doreen Y Agyeman, DMD
Individual provider Active NPI General Practice Dentistry · Fort Wayne, IN
NPI 1932402609 · NPPES record last updated Dec 17, 2010
Key facts
- NPI
- 1932402609
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 12011564A (IN)
- Practice address
- 1852 Bluffton Rd
Fort Wayne, IN 46809-1306 - Phone
- (260) 479-1086
- NPI assigned
- Dec 17, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160217002206 | IN | Order and Referring Only - Dentist |
3779888482 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12011564A | IN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kool Smiles in Ft. Wayne, PC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12011564A | IN | Yes |
Addresses
Primary practice location
1852 Bluffton Rd
Fort Wayne, IN 46809-1306
Mailing address
1090 Northchase Pkwy SE
Suite 290
Marietta, GA 30067-6405
Phone (678) 904-5665
Other providers in Fort Wayne, IN
- Danielle Aguilar
- Mary Kathleen Aguilar
- Gabriel Aguilera
- Christianah Agunanne
- Umunna Agunanne
- Vinit Anil Aher
- Abid Ali Ahmad
- Hani Ahmad
- Hasan Bilal Ahmad
- Muhammod Ahmad
All providers in Fort Wayne, IN · General Practice Dentistry in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.