Detailed Dental

Primary specialty

DentistTaxonomy code 122300000X

License

12011020 Issued in IN

Legal business name

DETAILED DENTAL

Practice address

13963 Morse St
Cedar Lake, IN 46303-9639

Phone

(219) 374-2400

NPI assigned

Jan 7, 2010

Organization subpart

No

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

Authorized official

Name

Christine Gudas

Title

Owner

Phone

(219) 374-2400

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1262822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262822400000",
    "number": "1215267661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13963 MORSE ST",
            "city": "CEDAR LAKE",
            "state": "IN",
            "postal_code": "463039639",
            "telephone_number": "219-374-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13963 MORSE ST",
            "city": "CEDAR LAKE",
            "state": "IN",
            "postal_code": "463039639",
            "telephone_number": "219-374-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DETAILED DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-07",
        "last_updated": "2010-01-07",
        "status": "A",
        "authorized_official_last_name": "GUDAS",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "219-374-2400"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12011020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zackary Thomas Collins, PHARMD.
• Robin L Dal Santo, COTA/L
• Clara Damarjian
• Jean Marie Decavitch, NP-C
• Jenna Marie Demy, PHARMD.
• Thomas Leroy Dexter III
• Brian Vincent Dieckmann, PSYD
• Brittany Rae Disterheft, OD
• Lisa Antoinette Duffley-Kazmierski, D.T.
• Edgewater Systems for Balanced Living, Inc

• Dentist in Cedar Lake, IN
• Providers in Cedar Lake, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 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.