Individual provider Active NPI

Dale Donald Pleak, D.D.S.

  • General Practice Dentistry
  • Greenfield, IN
National Provider Identifier
1104914787
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Practice address
626 N State St
Greenfield, IN 46140-1402
Phone
(317) 462-9480
Fax
(317) 462-2794
NPI assigned
Oct 10, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X IN Primary

Addresses

Primary practice location

626 N State St
Greenfield, IN 46140-1402

Mailing address

626 N State St
Greenfield, IN 46140-1402
Phone (317) 462-9480

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160122001145 IN Order and Referring Only - DentistPractitioner - Dentist 4385947597

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
047731030INMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104914787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 N STATE ST",
            "city": "GREENFIELD",
            "state": "IN",
            "postal_code": "461401402",
            "telephone_number": "317-462-9480",
            "fax_number": "317-462-2794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 N STATE ST",
            "city": "GREENFIELD",
            "state": "IN",
            "postal_code": "461401402",
            "telephone_number": "317-462-9480",
            "fax_number": "317-462-2794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PLEAK",
        "first_name": "DALE",
        "middle_name": "DONALD",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenfield, IN

Sources for this page

Verify at the official NPI Registry.