Active NPI
Mark Jurek
- Dentist
- Plymouth, IN
National Provider Identifier
1154798262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12012343A
- Practice address
- 556 N Oak Dr
Plymouth, IN 46563-1664 - Phone
- (574) 936-3921
- NPI assigned
- Aug 24, 2015
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 12012343A | IN | Primary |
Addresses
Primary practice location
556 N Oak Dr
Plymouth, IN 46563-1664
Mailing address
483 Wexford Rd
Valparaiso, IN 46385-8046
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 |
|---|---|---|---|
| 12012343A | IN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440374400000",
"number": "1154798262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "483 WEXFORD RD",
"city": "VALPARAISO",
"state": "IN",
"postal_code": "463858046"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "556 N OAK DR",
"city": "PLYMOUTH",
"state": "IN",
"postal_code": "465631664",
"telephone_number": "574-936-3921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUREK",
"first_name": "MARK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-08-24",
"last_updated": "2015-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12012343A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 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.