MEDICARE: AFFORDABLE DENTURES - FORT WAYNE, P.C.

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	122300000X	Dentist	12009930A	IN

General Provider Information

NPI Number	:	1932248788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE DENTURES - FORT WAYNE, P.C.

Provider Business Mailing Address
First Line	:	7810 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4138
Country	:	US
Telephone Number	:	260-436-7175
Fax Number	:

Provider Business Practice Location Address
First Line	:	7810 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4138
Country	:	US
Telephone Number	:	260-436-7175
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAWN J BENSON
Credential	:	DDS
Telephone Number	:	260-436-7175

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	08/22/2020

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