Individual provider Active NPI

Louis D Menegotto, D.D.S.PROSTHODONTIST

  • Prosthodontics
  • Indianapolis, IN
National Provider Identifier
1053403022
Registry record updated Feb 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
12009826 Issued in IN
Practice address
1121 W Michigan St
Indianapolis, IN 46202-5211
Phone
(317) 271-3079
NPI assigned
Sep 28, 2006
Last updated
Feb 25, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 25, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 12009826 IN
Prosthodontics 1223P0700X 12009826 IN Primary

Addresses

Primary practice location

1121 W Michigan St
Indianapolis, IN 46202-5211

Mailing address

1121 W Michigan St # a
Indianapolis, IN 46202-5211
Phone (317) 271-3079

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160209000345 IN Order and Referring Only - DentistPractitioner - Dentist 5294039459

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12009826INMDProsthodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Complete Dental Care of Avon P.C. 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740441600000",
    "number": "1053403022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 W MICHIGAN ST # A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025211",
            "telephone_number": "317-271-3079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 W MICHIGAN ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025211",
            "telephone_number": "317-271-3079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENEGOTTO",
        "first_name": "LOUIS",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.D.S.PROSTHODONTIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2025-02-25",
        "certification_date": "2025-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12009826",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "IN",
            "license": "12009826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.