Active NPI
Parker Durant Groom, DDS
- General Practice Dentistry
- Fort Wayne, IN
National Provider Identifier
1023701182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12014105A
- Practice address
- 10010 Dupont Circle CT
Fort Wayne, IN 46825-1626 - Phone
- (260) 490-9949
- NPI assigned
- Jun 2, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12014105A | IN | Primary |
Addresses
Primary practice location
10010 Dupont Circle CT
Fort Wayne, IN 46825-1626
Mailing address
10010 Dupont Circle CT
Fort Wayne, IN 46825-1626
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12014105A | IN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| R M & M R Stetzel DDS Inc | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685664000000",
"number": "1023701182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10010 DUPONT CIRCLE CT",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468251626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10010 DUPONT CIRCLE CT",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468251626",
"telephone_number": "260-490-9949"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROOM",
"first_name": "PARKER",
"middle_name": "DURANT",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-06-02",
"last_updated": "2023-06-02",
"certification_date": "2023-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IN",
"license": "12014105A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.