Provider Demographics
NPI:1396858957
Name:ORTHODONTIC SPECIALTY SERVICES, INC.
Entity Type:Organization
Organization Name:ORTHODONTIC SPECIALTY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGUE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:260-497-0497
Mailing Address - Street 1:1120 E DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1556
Mailing Address - Country:US
Mailing Address - Phone:260-497-0497
Mailing Address - Fax:260-489-4853
Practice Address - Street 1:1120 E DUPONT RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1556
Practice Address - Country:US
Practice Address - Phone:260-497-0497
Practice Address - Fax:260-489-4853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006000A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty