Kevin Patrick Bedford, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12014453A Issued in IN

Practice address

330 Park PL
Mishawaka, IN 46545-3555

Phone

(574) 259-9956

NPI assigned

Jun 7, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Matthew S Brennan DDS Inc

  • General Practice Dentistry
  • Mishawaka, IN
  • NPI 1316092190
  NPD
• Dental Professionals of Indiana, P.C.

  • General Practice Dentistry
  • Mishawaka, IN
  • NPI 1205372356
  NPD (past)

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

{
    "created_epoch": "1717718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717718400000",
    "number": "1063254415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15817 GATESHEAD DR",
            "city": "WESTFIELD",
            "state": "IN",
            "postal_code": "460745035",
            "telephone_number": "570-390-0933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 PARK PL",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453555",
            "telephone_number": "574-259-9956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEDFORD",
        "first_name": "KEVIN",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-07",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12014453A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Hope Beaird
• Trinity Bean
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• Hillary J Beck
• Ermina Begovic
• Jennifer Lynn Behnke
• Mary Lumma Behrens, PT
• Benjamin Beirich
• Bernardo E Beker, M.D.

• Dentist in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2024; 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.