NPIMap

Organization Active NPI

Decatur Dental Services, Inc.

Doing business as Bluffton Dental Clinic

  • General Practice Dentistry
  • Bluffton, IN
National Provider Identifier
1144480179
Registry record updated Apr 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12010359 Issued in IN
Legal business name
DECATUR DENTAL SERVICES, INC.
Doing business as
Bluffton Dental Clinic
Practice address
1417 Baker PL
Bluffton, IN 46714-1180
Phone
(260) 824-5940
NPI assigned
Jun 12, 2008
Last updated
Apr 10, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
DECATUR DENTAL SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 10, 2025

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

Authorized official

Name
Pamela JohnsonNPI 1023176575
Title
Dentist
Phone
(260) 824-5940

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 12010359 IN Primary

Addresses

Primary practice location

1417 Baker PL
Bluffton, IN 46714-1180

Mailing address

1417 Baker PL
Bluffton, IN 46714-1180
Phone (260) 824-5940

Other identifiers 1

IdentifierTypeStateIssuer
200379120AMedicaidIN

Other names 1

  • Bluffton Dental Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Decatur Dental Services5 organizations share this tax ID, including this one
Part of
Decatur Dental Services

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1417 Baker Pl
Bluffton, IN 46714
Phone (260) 824-5940

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.

NPI Registry JSON

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

{
    "created_epoch": "1213228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744243200000",
    "number": "1144480179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1417 BAKER PL",
            "city": "BLUFFTON",
            "state": "IN",
            "postal_code": "467141180",
            "telephone_number": "260-824-5940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 BAKER PL",
            "city": "BLUFFTON",
            "state": "IN",
            "postal_code": "467141180",
            "telephone_number": "260-824-5940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECATUR DENTAL SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DECATUR DENTAL SERVICES, INC.",
        "enumeration_date": "2008-06-12",
        "last_updated": "2025-04-10",
        "certification_date": "2025-04-10",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "260-824-5940"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200379120A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bluffton Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bluffton, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2025; 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.