NPIMap

Organization Active NPI

J Matthew Cronkhite DDS PC

  • Dentist
  • Lafayette, IN
National Provider Identifier
1003296955
Registry record updated Jun 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12010734A Issued in IN
Legal business name
J MATTHEW CRONKHITE DDS PC
Practice address
3667 Braddock Dr Ste B
Lafayette, IN 47909-7302
Phone
(765) 471-6025
NPI assigned
Jun 5, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marti Stichter
Title
Office Manager
Phone
(765) 471-6025

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 12010734A IN Primary

Addresses

Primary practice location

3667 Braddock Dr Ste B
Lafayette, IN 47909-7302

Mailing address

3667 Braddock Dr Ste B
Lafayette, IN 47909-7302
Phone (765) 471-6025

Other identifiers 1

IdentifierTypeStateIssuer
200860550MedicaidIN

National Provider Directory

National Provider Directory

Locations

3667 Braddock Dr
Ste B
Lafayette, IN 47909
Phone (765) 471-6025

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433462400000",
    "number": "1003296955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3667 BRADDOCK DR STE B",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479097302",
            "telephone_number": "765-471-6025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3667 BRADDOCK DR STE B",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479097302",
            "telephone_number": "765-471-6025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J MATTHEW CRONKHITE DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-05",
        "last_updated": "2015-06-05",
        "status": "A",
        "authorized_official_last_name": "STICHTER",
        "authorized_official_first_name": "MARTI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "765-471-6025"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12010734A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200860550",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.