Active NPI
Dagmara Ventresca, DDS
- Dentist
- Lafayette, IN
National Provider Identifier
1083021687
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12012167A
- Practice address
- 3554 Promenade Pkwy
Suite D
Lafayette, IN 47909-8417 - Phone
- (765) 838-3550
- NPI assigned
- Jul 15, 2014
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 12012167A | IN | Primary |
Addresses
Primary practice location
3554 Promenade Pkwy
Suite D
Lafayette, IN 47909-8417
Mailing address
11 S Mill St Ste 200
New Castle, PA 16101-3680
Phone (724) 698-2132
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201321760 | Medicaid | IN |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160224001445 | IN | Order and Referring Only - Dentist | 4688979958 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12012167A | IN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507680000000",
"number": "1083021687",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 S MILL ST STE 200",
"city": "NEW CASTLE",
"state": "PA",
"postal_code": "161013680",
"telephone_number": "724-698-2132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3554 PROMENADE PKWY",
"address_2": "SUITE D",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479098417",
"telephone_number": "765-838-3550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VENTRESCA",
"first_name": "DAGMARA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-15",
"last_updated": "2017-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12012167A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201321760",
"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 Oct 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.