St. John Premier Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ST. JOHN PREMIER DENTAL

Practice address

10271 Calumet Ave.
#103
St. John, IN 46373

Phone

(219) 627-7000

Fax

(219) 627-9627

NPI assigned

Jul 7, 2026

Organization subpart

No

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

Authorized official

Name

Dr. Peter William Straka, DMD

Title

Owner

Phone

(219) 627-7000

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1783382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783382400000",
    "number": "1093633133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10271 CALUMET AVE.",
            "address_2": "#103",
            "city": "ST. JOHN",
            "state": "IN",
            "postal_code": "46373",
            "telephone_number": "219-627-7000",
            "fax_number": "219-627-9627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10271 CALUMET AVE.",
            "address_2": "#103",
            "city": "ST. JOHN",
            "state": "IN",
            "postal_code": "46373",
            "telephone_number": "219-627-7000",
            "fax_number": "219-627-9627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHN PREMIER DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-07-07",
        "last_updated": "2026-07-07",
        "certification_date": "2026-06-15",
        "status": "A",
        "authorized_official_last_name": "STRAKA",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "219-627-7000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2026; 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.