Detail Dental

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

DETAIL DENTAL

Practice address

1030 Country Club Rd
Indianapolis, IN 46234-1813

Phone

(617) 271-1486

NPI assigned

Jul 23, 2019

Organization subpart

No

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

Authorized official

Name

Chris Chrisler, DDS

Title

Owner

Phone

(617) 617-9644

Specialties & licenses 1

Addresses

Other names 2

• Detail Dental Former legal business name
• Detail Dental, LLC Other name

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

{
    "created_epoch": "1563840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574208000000",
    "number": "1336792977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 COUNTRY CLUB RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462341813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 COUNTRY CLUB RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462341813",
            "telephone_number": "617-271-1486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DETAIL DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-23",
        "last_updated": "2019-11-20",
        "status": "A",
        "authorized_official_last_name": "CHRISLER",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-617-9644",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Detail Dental",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Detail Dental, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Colette Anne Despain, NP
• Negatu B Desta
• Bradley Scott Destefano, MD
• Destin'D Care Personal Service Agency
• Jacob Destrampe
• Samantha Detar, LMHCA
• Adam Gentry Detig, PA-C
• Celestine Detrana, M.D.
• Lacy Detterich, LMHC
• Michael E Dettner, MS, LMHC

• Dental Clinic/Center in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Dental Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2019; 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.