NPIMap

Organization Active NPI

Northeast Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Indianapolis, IN
National Provider Identifier
1285847376
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
12009571A Issued in IN
Legal business name
NORTHEAST ORTHODONTICS
Practice address
7205 North Shadeland Avenue
Indianapolis, IN 46250
Phone
(317) 849-0110
Fax
(317) 845-8845
NPI assigned
May 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Marisa A Walker, DDS MSPNPI 1376891200
Title
Owner
Phone
(317) 849-0110

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X 12009571A IN Primary

Addresses

Primary practice location

7205 North Shadeland Avenue
Indianapolis, IN 46250

Mailing address

7205 North Shadeland Avenue
Indianapolis, IN 46250
Phone (317) 849-0110

National Provider Directory

National Provider Directory

Locations

7205 N Shadeland Ave
Indianapolis, IN 46250
Phone (317) 849-0110

Practitioners & affiliated clinicians

Practitioners 2

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": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285847376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7205 NORTH SHADELAND AVENUE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46250",
            "telephone_number": "317-849-0110",
            "fax_number": "317-845-8845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7205 NORTH SHADELAND AVENUE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46250",
            "telephone_number": "317-849-0110",
            "fax_number": "317-845-8845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST ORTHODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "MARISA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-849-0110",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DDS MSP"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IN",
            "license": "12009571A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.