Provider Demographics
NPI:1316657463
Name:ONE FAMILY DENTAL
Entity type:Organization
Organization Name:ONE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SUDHAKAR
Authorized Official - Middle Name:SANTHANA
Authorized Official - Last Name:KRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-750-0418
Mailing Address - Street 1:10404 ANTELOPE CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4909
Mailing Address - Country:US
Mailing Address - Phone:260-750-0418
Mailing Address - Fax:
Practice Address - Street 1:2826 S STATE ROAD 135 STE C
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-9603
Practice Address - Country:US
Practice Address - Phone:260-750-0418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental