Pro Dental in 1 PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PRO DENTAL IN 1 PC

Practice address

1738 165TH St
Hammond, IN 46320-2814

Phone

(219) 844-8000

Fax

(219) 844-8008

NPI assigned

Sep 19, 2024

Organization subpart

No

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

Authorized official

Name

Simone Wilson-Adeleke, MPA-PPA

Title

Director of Credentialing

Phone

(732) 731-8398

Specialties & licenses 1

Addresses

Other names 1

• Destiny Dental of Hammond Doing business as

Tax ID family

Destiny Dental of Hammond2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pro Dental in 1 PC

  • Dentist
  • Indianapolis, IN
  • NPI 1760219299
  NPD tax ID

Locations

Practitioners 3

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

• Bao Truong, DMD

  • Dentist
  • Hammond, IN
  • NPI 1144874470
  NPD
• Parth Patel, DMD

  • General Practice Dentistry
  • Hammond, IN
  • NPI 1235659723
  NPD (past)
• Sasha Sarin

  • Dentist
  • Chicago, IL
  • NPI 1760261085
  NPD (past)

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

{
    "created_epoch": "1726704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726704000000",
    "number": "1316774698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 WOODBRIDGE CENTER DR STE 520",
            "city": "WOODBRIDGE",
            "state": "NJ",
            "postal_code": "070951152",
            "telephone_number": "732-731-8398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1738 165TH ST",
            "city": "HAMMOND",
            "state": "IN",
            "postal_code": "463202814",
            "telephone_number": "219-844-8000",
            "fax_number": "219-844-8008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO DENTAL IN 1 PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-19",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A",
        "authorized_official_last_name": "WILSON-ADELEKE",
        "authorized_official_first_name": "SIMONE",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "732-731-8398",
        "authorized_official_credential": "MPA-PPA"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Destiny Dental of Hammond",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dale Poortenga, FNP
• Amanda Rose Popovich
• Prairie Healthcare Services LLC
• Premise Health of Indiana Medical PC
• Brittany Press, RN
• Diego Puentez
• Purdue University
• Purpose Partner
• Julia Pysh
• Bianca Yasmin Rafidia Vargas, NP

• General Practice Dentistry in Hammond, IN
• Providers in Hammond, 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 19, 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.