MEDICARE: APEX DENTAL FORT WAYNE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1356289128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APEX DENTAL FORT WAYNE LLC

Provider Business Mailing Address
First Line	:	3601 HOBSON RD STE 101
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4537
Country	:	US
Telephone Number	:	260-215-9155
Fax Number	:	260-215-9156

Provider Business Practice Location Address
First Line	:	3601 HOBSON RD STE 101
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4537
Country	:	US
Telephone Number	:	260-215-9155
Fax Number	:	260-215-9156

Authorized Official
Title or Position	:	MEMBER/OWNER
Name	:	DR. SURESH KUMAR VARMA VEGESANA
Credential	:	DDS
Telephone Number	:	270-243-0098

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “APEX DENTAL FORT WAYNE LLC ” Practice Location

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