NPIMap

Organization Active NPI

Idc Dental Group, Inc.

  • General Practice Dentistry
  • Indianapolis, IN
National Provider Identifier
1093164535
Registry record updated Jun 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12012473A Issued in IN
Legal business name
IDC DENTAL GROUP, INC.
Practice address
5150 E Stop 11 Rd
Suite 11
Indianapolis, IN 46237-8628
Phone
(317) 889-6000
Fax
(317) 889-1618
NPI assigned
Jun 6, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2016

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

Authorized official

Name
Dr. Kellie Michelle Schaub, DDS, MSD
Title
Owner/President
Phone
(317) 884-8633

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 12007400A IN
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 12012473A IN Primary

Addresses

Primary practice location

5150 E Stop 11 Rd
Suite 11
Indianapolis, IN 46237-8628

Mailing address

8445 S Emerson Ave
Suite 101
Indianapolis, IN 46237-9596
Phone (317) 884-8633

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1465171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465171200000",
    "number": "1093164535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8445 S EMERSON AVE",
            "address_2": "SUITE 101",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462379596",
            "telephone_number": "317-884-8633",
            "fax_number": "317-300-1896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 E STOP 11 RD",
            "address_2": "SUITE 11",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462378628",
            "telephone_number": "317-889-6000",
            "fax_number": "317-889-1618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDC DENTAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-06",
        "last_updated": "2016-06-06",
        "status": "A",
        "authorized_official_last_name": "SCHAUB",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "317-884-8633",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MSD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12007400A",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12012473A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2016; 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.