Active NPI
Logan Charles Goodrich, DMD
- Dentist
- Fort Wayne, IN
National Provider Identifier
1225654882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12013386A
- Practice address
- 1234 E Dupont Rd Ste 4
Fort Wayne, IN 46825-1545 - Phone
- (260) 490-3495
- NPI assigned
- Jun 19, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12013386A | IN | Primary |
Addresses
Primary practice location
1234 E Dupont Rd Ste 4
Fort Wayne, IN 46825-1545
Mailing address
8429 Hunters Knoll Run
Fort Wayne, IN 46825-6406
Phone (260) 515-8864
Other practice location 1
4302 E State Blvd
Fort Wayne, IN 46815-6988
Phone (260) 484-3136
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12013386A | IN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Middleton Family Dentistry LLC | Dentist | Past | Accepting new patients |
| Charles H Middleton DDS PC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Fort Wayne, IN
- NPI 1215024989
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592524800000",
"number": "1225654882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8429 HUNTERS KNOLL RUN",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468256406",
"telephone_number": "260-515-8864"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1234 E DUPONT RD STE 4",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468251545",
"telephone_number": "260-490-3495"
}
],
"practiceLocations": [
{
"address_1": "4302 E State Blvd",
"address_purpose": "LOCATION",
"city": "Fort Wayne",
"state": "IN",
"postal_code": "468156988",
"country_code": "US",
"telephone_number": "260-484-3136",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GOODRICH",
"first_name": "LOGAN",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-19",
"last_updated": "2020-06-19",
"certification_date": "2020-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12013386A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 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.