Advanced Dental Care of Fortville, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

ADVANCED DENTAL CARE OF FORTVILLE, LLC

Practice address

545 Vitality Dr Ste F
Fortville, IN 46040-1373

Phone

(317) 485-7000

NPI assigned

Jul 8, 2020

Last updated

Jul 8, 2020By 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

Jack Summerlin III, DDS

Title

Owner

Phone

(765) 485-7000

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1594166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594166400000",
    "number": "1205454014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 VITALITY DR STE F",
            "city": "FORTVILLE",
            "state": "IN",
            "postal_code": "460401373",
            "telephone_number": "317-485-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 VITALITY DR STE F",
            "city": "FORTVILLE",
            "state": "IN",
            "postal_code": "460401373",
            "telephone_number": "317-485-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DENTAL CARE OF FORTVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-08",
        "last_updated": "2020-07-08",
        "certification_date": "2020-07-08",
        "status": "A",
        "authorized_official_last_name": "SUMMERLIN",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "765-485-7000",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Fortville",
            "affiliation": "N",
            "address_1": "545 Vitality Dr Ste F",
            "city": "Fortville",
            "state": "IN",
            "country_code": "US",
            "postal_code": "460401373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Anna Acklin
• Michele Valenton Anthony, LCSW
• Apex Healthcare Services, LLC
• Rachel Boes
• Adaliah D Brown, MA, LMHCA
• Travis B Bunnell, O.D

• Dental Clinic/Center in Fortville, IN
• Providers in Fortville, IN by specialty
• Dental Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2020; 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.