Northeast Indiana Orthodontics, LLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

NORTHEAST INDIANA ORTHODONTICS, LLC

Practice address

2121 E Dupont Rd Ste D
Fort Wayne, IN 46825-1546

Phone

(260) 338-2643

NPI assigned

Dec 12, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Allison Bergdoll, DDS, MSNPI 1013234640

Title

President, Orthodontist

Phone

(260) 338-2643

Specialties & licenses 2

Addresses

Locations

Practitioners 2

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

• Allison Bergdoll, DDS, MS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Fort Wayne, IN
  • NPI 1013234640
  NPD Authorized official
• Warren Travis, DDS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Fort Wayne, IN
  • NPI 1982433181
  NPD

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

{
    "created_epoch": "1733961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733961600000",
    "number": "1982411088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 E DUPONT RD STE D",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251546",
            "telephone_number": "260-338-2643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 E DUPONT RD STE D",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251546",
            "telephone_number": "260-338-2643"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "516 N Line St",
            "address_purpose": "LOCATION",
            "city": "Columbia City",
            "state": "IN",
            "postal_code": "467251230",
            "country_code": "US",
            "telephone_number": "260-338-2643",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHEAST INDIANA ORTHODONTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-12",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A",
        "authorized_official_last_name": "BERGDOLL",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_title_or_position": "PRESIDENT, ORTHODONTIST",
        "authorized_official_telephone_number": "260-338-2643",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Northeast Indiana Urology, P.C.
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• Northeast Indiana Urology. P.C.

• Orthodontics and Dentofacial Orthopedics Dentistry in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; 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.