NPIMap

Organization Active NPI

Adolescent & Pediactric Dentistry P.C.

  • Pediatric Dentistry
  • Muncie, IN
National Provider Identifier
1184882219
Registry record updated May 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
12010472A Issued in IN
Legal business name
ADOLESCENT & PEDIACTRIC DENTISTRY P.C.
Practice address
610 S Tillotson Ave Ste 205
Muncie, IN 47304-4450
Phone
(765) 288-5527
Fax
(765) 288-6119
NPI assigned
May 27, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2008

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

Authorized official

Name
Dr. Michael Richard Musal, D.D.S.NPI 1932230992
Title
Owner
Phone
(765) 288-5527

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
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 12010472A IN Primary

Addresses

Primary practice location

610 S Tillotson Ave Ste 205
Muncie, IN 47304-4450

Mailing address

610 S Tillotson Ave Ste 205
Muncie, IN 47304-4450
Phone (765) 288-5527

Other identifiers 1

IdentifierTypeStateIssuer
200408960AMedicaidIN

National Provider Directory

National Provider Directory

Locations

610 S Tillotson Ave
Ste 205
Muncie, IN 47304
Phone (765) 288-5527

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1211846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211846400000",
    "number": "1184882219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 S TILLOTSON AVE STE 205",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473044450",
            "telephone_number": "765-288-5527",
            "fax_number": "765-288-6119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 S TILLOTSON AVE STE 205",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473044450",
            "telephone_number": "765-288-5527",
            "fax_number": "765-288-6119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADOLESCENT & PEDIACTRIC DENTISTRY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-27",
        "last_updated": "2008-05-27",
        "status": "A",
        "authorized_official_last_name": "MUSAL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "765-288-5527",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IN",
            "license": "12010472A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200408960A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Muncie, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2008; 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.