NPIMap

Organization Active NPI

Heartland Dental Care of Indiana, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Kokomo, IN
National Provider Identifier
1346452448
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
HEARTLAND DENTAL CARE OF INDIANA, PC
Doing business as
21st Century Oral Surgery
Practice address
2016 S Elizabeth St
Kokomo, IN 46902
Phone
(765) 452-0028
Fax
(765) 452-0890
NPI assigned
May 3, 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
Amy Kroeger
Title
Ins Cood
Phone
(217) 540-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

2016 S Elizabeth St
Kokomo, IN 46902

Mailing address

2016 S Elizabeth St
Kokomo, IN 46902
Phone (765) 452-0028

Other names 1

  • 21st Century Oral Surgery Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heartland Dental Care of Indiana PC48 organizations share this tax ID, including this one

Other organizations with this tax ID 47

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

View all 47

Locations

2016 S Elizabeth St
Kokomo, IN 46902
Phone (765) 450-4776

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1346452448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2016 S ELIZABETH ST",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "46902",
            "telephone_number": "765-452-0028",
            "fax_number": "765-452-0890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2016 S ELIZABETH ST",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "46902",
            "telephone_number": "765-452-0028",
            "fax_number": "765-452-0890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND DENTAL CARE OF INDIANA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KROEGER",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "INS COOD",
        "authorized_official_telephone_number": "217-540-5100"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "21st Century Oral Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kokomo, 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.