Active NPI
Edgewood Dental, LLP
- General Practice Dentistry
- Michigan City, IN
National Provider Identifier
1124542139
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12009354
- Legal business name
- EDGEWOOD DENTAL, LLP
- Practice address
- 3008 Franklin St
Michigan City, IN 46360-4636 - Phone
- (219) 872-2110
- Fax
- (219) 872-1082
- NPI assigned
- Aug 1, 2017
- Last updated
- Aug 1, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Valerie Haughtington, DDS
- Title
- Partner/Dentist
- Phone
- (219) 872-2110
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12009354 | Primary |
Addresses
Primary practice location
3008 Franklin St
Michigan City, IN 46360-4636
Mailing address
3008 Franklin St
Michigan City, IN 46360
Phone (219) 872-2110
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053411645 | Other | IN | PROVIDER NPI |
| 100376490B | Medicaid | IN | |
| 1245390236 | Other | IN | PROVIDER NPI |
National Provider Directory
National Provider DirectoryLocations
3008 Franklin St
Michigan City, IN 46360
Phone (219) 872-2110
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- General Practice Dentistry
- Michigan City, IN
- NPI 1245390236
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501545600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1501545600000",
"number": "1124542139",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3008 FRANKLIN ST",
"city": "MICHIGAN CITY",
"state": "IN",
"postal_code": "46360",
"telephone_number": "219-872-2110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3008 FRANKLIN ST",
"city": "MICHIGAN CITY",
"state": "IN",
"postal_code": "463604636",
"telephone_number": "219-872-2110",
"fax_number": "219-872-1082"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EDGEWOOD DENTAL, LLP",
"organizational_subpart": "NO",
"enumeration_date": "2017-08-01",
"last_updated": "2017-08-01",
"status": "A",
"authorized_official_last_name": "HAUGHTINGTON",
"authorized_official_first_name": "VALERIE",
"authorized_official_title_or_position": "PARTNER/DENTIST",
"authorized_official_telephone_number": "219-872-2110",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": null,
"license": "12009354",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROVIDER NPI",
"identifier": "1053411645",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100376490B",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROVIDER NPI",
"identifier": "1245390236",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Michigan City, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.