Active NPI
Sandra E Bacon, DDS
- General Practice Dentistry
- Carmel, IN
National Provider Identifier
1164539318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12009028
- Practice address
- 1980 E 116TH Street
Ste 150
Carmel, IN 46032 - Phone
- (317) 848-1771
- Fax
- (317) 848-1371
- NPI assigned
- Aug 24, 2006
- Sex
- Female
- 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 | 12009028 | IN | Primary |
Addresses
Primary practice location
1980 E 116TH Street
Ste 150
Carmel, IN 46032
Mailing address
1980 E 116TH Street
Ste 150
Carmel, IN 46032
Phone (317) 848-1771
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12009028B | Other | IN | IN BOARD OF PHARMACY CSR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160302000384 | IN | Order and Referring Only - Other (Physician) | 2961707849 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12009028 | IN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carmel Dental Care, PC | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1164539318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1980 E 116TH STREET",
"address_2": "STE 150",
"city": "CARMEL",
"state": "IN",
"postal_code": "46032",
"telephone_number": "317-848-1771",
"fax_number": "317-848-1371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1980 E 116TH STREET",
"address_2": "STE 150",
"city": "CARMEL",
"state": "IN",
"postal_code": "46032",
"telephone_number": "317-848-1771",
"fax_number": "317-848-1371"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACON",
"first_name": "SANDRA",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-24",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IN",
"license": "12009028",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IN BOARD OF PHARMACY CSR",
"identifier": "12009028B",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Carmel, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.