FAMILIA DENTAL SPFW PLLC (NPI# 1619388063) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619388063 |
| Entity Type | Organization |
| Organization Name | FAMILIA DENTAL SPFW PLLC |
| Practice Address |
100 E Pettit Ave 1a Fort Wayne IN 46806-3003 |
| Mailing Address |
2050 E Algonquin Rd Suite 610 Schaumburg IL 60173-4144 |
| Practice Telephone | 8889884066 |
| Practice Fax Number | 8474967603 |
| Mailing Telephone | 8889884066 |
| Mailing Fax Number | 8474967603 |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2014-10-22 |
| Authorized Official Name | DR. KOUSHAN AZAD (PRESIDENT) |
| Authorized Official Telephone | 8889884066 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Street Address |
100 E PETTIT AVE 1A |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46806-3003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841574829 | Daniel E Purvis Jr. | Pharmacist | 222 E Pettit Avenue, Fort Wayne, IN 46806 | 2011-10-07 |
| 1558645754 | Logan M Franke | Pharmacist | 222 E Pettit Ave, Fort Wayne, IN 46806 | 2011-10-06 |
| 1356513725 | Seazoned Med Transportation Service | Non-emergency Medical Transport (VAN) | 2809 Smith Street, Fort Wayne, IN 46806 | 2008-03-26 |
| 1376711267 | Hector F Perez Md PC | Family Medicine | 5717 So Anthony, Ste 500, Fort Wayne, IN 46806 | 2008-02-14 |
| 1326249376 | Purdue University | Dentist | 2700 South Lafayette Street, Fort Wayne, IN 46806 | 2007-05-29 |
| 1174657480 | Robert Anthony Ford | Case Manager/Care Coordinator | 525 Oxford St., Fort Wayne, IN 46806 | 2007-03-16 |
| 1508069972 | Indiana University | Clinic/Center | 2700 South Lafayette Street, Fort Wayne, IN 46806 | 2007-06-06 |
| 1669622403 | Sally J Hartman | Nurse Practitioner | 2700 S Lafayette St, Suite 200, Fort Wayne, IN 46806-1100 | 2008-09-30 |
| 1003099441 | Lafayette Foot and Ankle Clinic | Podiatrist | 2700 Lafayette St Ste 230, Fort Wayne, IN 46806-1100 | 2007-12-07 |
| 1033259197 | V E Butler and Associates PC | Pharmacist | 2700 S. Lafayette St, Communitycare Pharmacy, Fort Wayne, IN 46806-1100 | 2007-02-07 |
| Find all providers in zip 46806 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679186258 | James Patrick Thompson | Dentist | 5909 Wheelock Rd Ste 102, Fort Wayne, IN 46835-9258 | 2020-08-25 |
| 1295357481 | Sycamore Hills Dentistry | Dentist | 10082 Illinois Rd, Fort Wayne, IN 46804-5772 | 2020-05-11 |
| 1699324103 | Phillip M. Mckean Professional Corporation | Dentist | 6605 E State Blvd Ste 7, Fort Wayne, IN 46815-7036 | 2019-09-06 |
| 1598322083 | Charles Chase Ellinwood | Dentist | 5725 Maplecrest Rd Ste 1, Fort Wayne, IN 46835-4937 | 2019-05-21 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1821582172 | Jacob Yager | Dentist | 9830 Auburn Rd Ste 101, Fort Wayne, IN 46825-2464 | 2018-06-20 |
| 1740772656 | Colleen Rose Allen | Dentist | 10213 Dupont Circle Dr W, Fort Wayne, IN 46825-1656 | 2018-06-06 |
| 1407360910 | Grace Xinxing Clark | Dentist | 4716 Illinois Rd Ste 101, Fort Wayne, IN 46804-5123 | 2017-11-20 |
| 1578959375 | Ronald L Rumbaugh Dds PC | Dentist | 10506 Coldwater Rd, Fort Wayne, IN 46845-1235 | 2015-04-09 |
| 1467792663 | Familia Dental Fort Wayne Pllc | Dentist | 5328 Coldwater Rd, Fort Wayne, IN 46825-5445 | 2013-02-25 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46806 |
Please comment or provide details below to improve the information on FAMILIA DENTAL SPFW PLLC.
| 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.