Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 16929 | MA |
NPI | 1326153214 |
---|---|
Provider Name | Denise J Fedele |
First Address | Fort Wayne, IN 46805-5100 |
Second Address | Fort Wayne, IN 46805-5100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 25/06/2013 |