Active NPI
Stephen J Holka
- General Practice Dentistry
- Oaktown, IN
National Provider Identifier
1124199393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12010551A
- Practice address
- 100 N. Broadway Street
Oaktown, IN 47561-0269 - Phone
- (812) 745-4151
- NPI assigned
- Nov 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12010551A | IN | Primary |
Addresses
Primary practice location
100 N. Broadway Street
Oaktown, IN 47561-0269
Mailing address
100 N. Broadway Street
PO Box 269
Oaktown, IN 47561-0269
Phone (812) 745-4151
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200357310A | Medicaid | IN | |
| 200435290 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12010551A | IN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| L Renee Goodwin DDS Inc | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Oaktown, IN
- NPI 1568643948
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428278400000",
"number": "1124199393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 N. BROADWAY STREET",
"address_2": "PO BOX 269",
"city": "OAKTOWN",
"state": "IN",
"postal_code": "475610269",
"telephone_number": "812-745-4151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 N. BROADWAY STREET",
"city": "OAKTOWN",
"state": "IN",
"postal_code": "475610269",
"telephone_number": "812-745-4151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLKA",
"first_name": "STEPHEN",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-10",
"last_updated": "2015-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IN",
"license": "12010551A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200357310A",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200435290",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oaktown, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.