Amazing Dental

Primary specialty

DentistTaxonomy code 122300000X

License

12011105A Issued in IN

Legal business name

AMAZING DENTAL

Practice address

5200 Washington Ave
Suite E
Evansville, IN 47715-4863

Phone

(812) 488-2008

Fax

(812) 475-9831

NPI assigned

May 13, 2010

Last updated

May 13, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ruthie M Jimerson, DDS

Title

President

Phone

(812) 488-2008

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1273708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273708800000",
    "number": "1174841126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 WASHINGTON AVE",
            "address_2": "SUITE E",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477154863",
            "telephone_number": "812-488-2008",
            "fax_number": "812-475-9831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 WASHINGTON AVE",
            "address_2": "SUITE E",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477154863",
            "telephone_number": "812-488-2008",
            "fax_number": "812-475-9831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMAZING DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-13",
        "last_updated": "2010-05-13",
        "status": "A",
        "authorized_official_last_name": "JIMERSON",
        "authorized_official_first_name": "RUTHIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "812-488-2008",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12011105A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Evansville, IN
• Providers in Evansville, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 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.