Indiana Emergency Dental Bloomington LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

INDIANA EMERGENCY DENTAL BLOOMINGTON LLC

Practice address

1600 W Bloomfield Rd
Bloomington, IN 47403-2054

Phone

(463) 276-0541

NPI assigned

Aug 31, 2024

Organization subpart

No

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

Authorized official

Name

Edward Garry, DMDNPI 1255537353

Title

Owner, DMD

Phone

(317) 979-0078

Specialties & licenses 1

Addresses

Other names 1

• Indiana Emergency Dental Doing business as

Locations

Practitioners 1

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

• Edward G Garry, DMD

  • General Practice Dentistry
  • Indianapolis, IN
  • NPI 1255537353
  NPD Authorized official

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

{
    "created_epoch": "1725062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725494400000",
    "number": "1285468165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W BLOOMFIELD RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W BLOOMFIELD RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032054",
            "telephone_number": "463-276-0541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA EMERGENCY DENTAL BLOOMINGTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-31",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A",
        "authorized_official_last_name": "GARRY",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER, DMD",
        "authorized_official_telephone_number": "317-979-0078",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indiana Emergency Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Bloomington, IN
• Providers in Bloomington, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; 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.