Individual provider Active NPI

Janet Anne Pole, DDS

  • General Practice Dentistry
  • Indianapolis, IN
National Provider Identifier
1174639538
Registry record updated Nov 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12007890 Issued in IN
Practice address
3808 N Lawndale Ave
Indianapolis, IN 46254-2814
Phone
(317) 297-4502
Fax
(317) 297-4554
NPI assigned
Aug 21, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 16, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 12007890 IN Primary

Addresses

Primary practice location

3808 N Lawndale Ave
Indianapolis, IN 46254-2814

Mailing address

3808 N Lawndale Ave
Indianapolis, IN 46254-2814
Phone (317) 297-4502

Other identifiers 1

IdentifierTypeStateIssuer
100071380AMedicaidIN

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
12007890INMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
West 38TH Dental, LTD 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": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289865600000",
    "number": "1174639538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3808 N LAWNDALE AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462542814",
            "telephone_number": "317-297-4502",
            "fax_number": "317-297-4554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3808 N LAWNDALE AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462542814",
            "telephone_number": "317-297-4502",
            "fax_number": "317-297-4554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLE",
        "first_name": "JANET",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2010-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12007890",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100071380A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2010; 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.