The Dental Center of Mishawaka PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12008118 Issued in IN

Legal business name

THE DENTAL CENTER OF MISHAWAKA PC

Practice address

112 Ironworks Ave
Mishawaka, IN 46544-2057

Phone

(574) 255-4964

NPI assigned

May 11, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Rebecca M Nukes, CREDENTIALING MGR

Title

Business Manager

Phone

(574) 245-7503

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370908800000",
    "number": "1295940518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 IRONWORKS AVE",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465442057",
            "telephone_number": "574-255-4964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 IRONWORKS AVE",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465442057",
            "telephone_number": "574-255-4964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DENTAL CENTER OF MISHAWAKA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2013-06-11",
        "status": "A",
        "authorized_official_last_name": "NUKES",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "574-245-7503",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CREDENTIALING MGR"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12008118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Mishawaka, IN
• Providers in Mishawaka, 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 Jun 11, 2013; 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.