NPIMap

Organization Active NPI

Hewitt Dental Group of Elkhart, LTD.

  • General Practice Dentistry
  • Elkhart, IN
National Provider Identifier
1053648055
Registry record updated Nov 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12007801A Issued in IN
Legal business name
HEWITT DENTAL GROUP OF ELKHART, LTD.
Practice address
319 W Lusher Ave
Elkhart, IN 46517-1866
Phone
(574) 389-8300
NPI assigned
Nov 11, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2009

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

Authorized official

Name
Dr. Scott Hewitt, DDS
Title
President
Phone
(574) 532-3085

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 12007801A IN Primary

Addresses

Primary practice location

319 W Lusher Ave
Elkhart, IN 46517-1866

Mailing address

PO Box 806
Middlebury, IN 46540-0806
Phone (574) 229-8180

Other identifiers 1

IdentifierTypeStateIssuer
100222340MedicaidIN

National Provider Directory

National Provider Directory

Locations

319 W Lusher Ave
Elkhart, IN 46517
Phone (574) 389-8300

NPI Registry JSON

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

{
    "created_epoch": "1257897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257897600000",
    "number": "1053648055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 806",
            "city": "MIDDLEBURY",
            "state": "IN",
            "postal_code": "465400806",
            "telephone_number": "574-229-8180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 W LUSHER AVE",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465171866",
            "telephone_number": "574-389-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEWITT DENTAL GROUP OF ELKHART, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-11",
        "last_updated": "2009-11-11",
        "status": "A",
        "authorized_official_last_name": "HEWITT",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "574-532-3085",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12007801A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100222340",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkhart, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2009; 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.