Feltzer 2020 Dental Management LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

FELTZER 2020 DENTAL MANAGEMENT LLC

Practice address

965 Heathrow LN
Avon, IN 46123-6787

Phone

(317) 727-1534

NPI assigned

Jun 2, 2014

Organization subpart

Yes

Parent organization

20-20 DENTAL LLCAs reported in NPPES

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

Authorized official

Name

Dr. Ronald Prokes, DDS

Title

Cfo

Phone

(317) 727-1534

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1401667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401667200000",
    "number": "1104238658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 HEATHROW LN",
            "city": "AVON",
            "state": "IN",
            "postal_code": "461236787",
            "telephone_number": "317-727-1534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 HEATHROW LN",
            "city": "AVON",
            "state": "IN",
            "postal_code": "461236787",
            "telephone_number": "317-727-1534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FELTZER 2020 DENTAL MANAGEMENT LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "20-20 DENTAL LLC",
        "enumeration_date": "2014-06-02",
        "last_updated": "2014-06-02",
        "status": "A",
        "authorized_official_last_name": "PROKES",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "317-727-1534",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "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 Jun 2, 2014; 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.