PERIODONTICS LIMITED (NPI# 1053408609) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053408609 |
| Entity Type | Organization |
| Organization Name | PERIODONTICS LIMITED |
| Practice Address |
7750 W Jefferson Blvd Fort Wayne IN 46804-4174 |
| Practice Telephone | 2604320577 |
| Practice Fax Number | 2604320578 |
| Mailing Telephone | 2604320577 |
| Mailing Fax Number | 2604320578 |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. LLOYD J. HAGEDORN (SENIOR PARTNER) |
| Authorized Official Telephone | 2604320577 |
| Authorized Official Credential | DDS, MSD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers |
| Street Address |
7750 W JEFFERSON BLVD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-4174 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700857281 | Susan Lynn Eggebrecht | Optometrist | 7750 W Jefferson Blvd, Fort Wayne, IN 46804 | 2006-01-31 |
| 1447410501 | Periodontic Specialists, P.C. | Dentist | 7750 W Jefferson Blvd, Fort Wayne, IN 46804-4174 | 2008-06-12 |
| 1639250053 | Vision Care Associates PC | Technician/Technologist | 7750 W Jefferson Blvd, Fort Wayne, IN 46804-4174 | 2006-10-19 |
| 1306933916 | Daniel F. Gabrek | Dentist | 7750 W Jefferson Blvd, Fort Wayne, IN 46804-4174 | 2006-10-06 |
| 1235226861 | Lloyd J. Hagedorn | Dentist | 7750 W Jefferson Blvd, Fort Wayne, IN 46804-4174 | 2006-10-06 |
| 1861585655 | Vision Care Associates PC | Optometrist | 7750 W Jefferson Blvd, Fort Wayne, IN 46804 | 2006-10-02 |
| 1407860216 | Wayne Lee Dawes | Dentist | 7750 W Jefferson Blvd, Fort Wayne, IN 46804-4174 | 2006-07-28 |
| 1508830209 | Donald A Bollheimer | Ophthalmology | 7750 W Jefferson Blvd, Vision Care Associates PC, Fort Wayne, IN 46804 | 2006-02-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629031372 | Steven B Lee, Dds, PC | Dentist | 1320 Medical Park Dr, Fort Wayne, IN 46825-5844 | 2006-04-11 |
| 1447410501 | Periodontic Specialists, P.C. | Dentist | 7750 W Jefferson Blvd, Fort Wayne, IN 46804-4174 | 2008-06-12 |
| 1780880930 | Steven B Lee | Dentist | 1320 Medical Park Dr, Fort Wayne, IN 46825-5844 | 2007-06-25 |
| 1306933916 | Daniel F. Gabrek | Dentist | 7750 W Jefferson Blvd, Fort Wayne, IN 46804-4174 | 2006-10-06 |
| 1235226861 | Lloyd J. Hagedorn | Dentist | 7750 W Jefferson Blvd, Fort Wayne, IN 46804-4174 | 2006-10-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114524477 | Katherine E. Ferry | Dentist | 4303 E Windsor Ln, Columbus, IN 47201-4022 | 2020-10-08 |
| 1609421965 | Hawra Alqallaf | Dentist | 1121 W Michigan St # Ds422, Indianapolis, IN 46202-5211 | 2019-08-05 |
| 1952814238 | Center for Implant Denistry and Periodontics, LLC | Dentist | 9885 E 116th St Ste 300, Fishers, IN 46037-9242 | 2017-11-09 |
| 1518470897 | Meridian Street Periodontics, LLC | Dentist | 8801 N Meridian St Ste 103, Indianapolis, IN 46260-2353 | 2017-11-09 |
| 1538410451 | Eon Clinics Indiana LLC | Dentist | 10020 Calumet Ave, Munster, IN 46321-4055 | 2012-10-02 |
| 1164726832 | Indy East Periodontics PC | Dentist | 115 N Shortridge Rd Ste 100, Indianapolis, IN 46219-4917 | 2011-01-10 |
| 1588997183 | Shane T Cope Dds, PC | Dentist | 10435 Commerce Drive, Suite 120, Carmel, IN 46032 | 2009-09-14 |
| 1366697070 | Bruce B. Wiland, Dds, Msd | Dentist | 3415 S Lafountain St Ste K, Kokomo, IN 46902-3827 | 2008-11-21 |
| 1023267770 | James M. Humphrey | Dentist | 221 S. 19th Street, Terre Haute, IN 47807-4129 | 2008-09-17 |
| 1891968194 | James Kirk | Dentist | 500 W Lincoln Hwy Ste N, Merrillville, IN 46410 | 2008-04-08 |
| Find all providers with the same taxonomy | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.