NPI 1104592724 · live from the CMS NPI Registry
Anna M Betlej
Dentist, Orthodontics and Dentofacial Orthopedics in Fort Wayne, IN. National Provider Identifier 1104592724, active.
NPI record
| NPI | 1104592724 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dentist, Orthodontics and Dentofacial Orthopedics 1223X0400X |
| Practice location | 5328 Coldwater Rd, Fort Wayne, IN 46825 |
| Practice phone | 260-471-5016 |
| Enumerated | August 23, 2021 |
| Last updated | September 15, 2021 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, Orthodontics and Dentofacial Orthopedics primary | 1223X0400X | 12013698A (IN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.