Healthcare Provider Details

I. General information

NPI: 1336061191
Provider Name (Legal Business Name): SHUTONG AKMAL, DMD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4616 W JEFFERSON BLVD
FORT WAYNE IN
46804-6826
US

IV. Provider business mailing address

3321 TREVISO CV
FORT WAYNE IN
46814-8242
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-8414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHUTONG AKMAL
Title or Position: OWNER DENTIST
Credential: DMD
Phone: 828-719-5723