NPIMap

Organization Active NPI

Georgetown North Dental Care LLC

  • Dental Clinic/Center
  • Fort Wayne, IN
National Provider Identifier
1255849667
Registry record updated Jul 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
GEORGETOWN NORTH DENTAL CARE LLC
Practice address
6405 Georgetown North Blvd
Fort Wayne, IN 46815-7007
Phone
(260) 485-0583
NPI assigned
Jan 19, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2022

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

Authorized official

Name
Opal Anderson
Title
Regional Operations Manager
Phone
(260) 485-0583

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

6405 Georgetown North Blvd
Fort Wayne, IN 46815-7007

Mailing address

6405 Georgetown North Blvd
Fort Wayne, IN 46815-7007
Phone (260) 485-0583

Other names 1

  • Georgetown North Dental Group Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address office@georgetownnorthdental.com

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1516320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658275200000",
    "number": "1255849667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6405 GEORGETOWN NORTH BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468157007",
            "telephone_number": "260-485-0583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6405 GEORGETOWN NORTH BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468157007",
            "telephone_number": "260-485-0583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGETOWN NORTH DENTAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-19",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "OPAL",
        "authorized_official_title_or_position": "REGIONAL OPERATIONS MANAGER",
        "authorized_official_telephone_number": "260-485-0583"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "office@georgetownnorthdental.com",
            "affiliation": "N",
            "address_1": "6405 Georgetown North Blvd",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468157007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Georgetown North Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 20, 2022; 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.