1609606185 NPI number — MAPLE DENTAL DDS PC

Table of content: (NPI 1609606185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609606185 NPI number — MAPLE DENTAL DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAPLE DENTAL DDS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609606185
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14207 KIDD CREEK CROSSOVER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46845-0180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-801-2718
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6418 EST STATE BOULEVARD
Provider Second Line Business Practice Location Address:
STORE #23
Provider Business Practice Location Address City Name:
FORTWAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-601-3300
Provider Business Practice Location Address Fax Number:
833-563-2510
Provider Enumeration Date:
08/07/2024

Additional Information

Authorized Official

Authorized Official Last Name:
KAUR
Authorized Official First Name:
GURPREET
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
347-445-3453

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com