WTDG Specialty Group LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

WTDG SPECIALTY GROUP LLC

Practice address

6443 W 10TH St Ste 204
Indianapolis, IN 46214-6502

Phone

(317) 247-9512

NPI assigned

Mar 10, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Brent J Barta, DDS

Title

Member

Phone

(317) 679-8506

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1615334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615334400000",
    "number": "1114502283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6443 W 10TH ST STE 204",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462146502",
            "telephone_number": "317-247-9512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6443 W 10TH ST STE 204",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462146502",
            "telephone_number": "317-247-9512"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6443 W 10th St Ste 204",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462146502",
            "country_code": "US",
            "telephone_number": "317-247-9512",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WTDG SPECIALTY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-10",
        "last_updated": "2021-03-10",
        "certification_date": "2021-03-10",
        "status": "A",
        "authorized_official_last_name": "BARTA",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "317-679-8506",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "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 Mar 10, 2021; 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.