Indiju 5 Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

INDIJU 5 DENTAL LLC

Practice address

100 S 18TH St
Columbia, PA 17512-9596

Phone

(717) 991-8750

Fax

(717) 647-2106

NPI assigned

Jul 24, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Barry Allyn Moss, DMD

Title

President

Phone

(717) 991-8750

Specialties & licenses 1

Addresses

Other names 1

• Susghuena Dental Associates Doing business as

Locations

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

{
    "created_epoch": "1595548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595548800000",
    "number": "1346859402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 DUNHAM DR",
            "city": "HUMMELSTOWN",
            "state": "PA",
            "postal_code": "170368040",
            "telephone_number": "717-991-8750",
            "fax_number": "717-647-2106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S 18TH ST",
            "city": "COLUMBIA",
            "state": "PA",
            "postal_code": "175129596",
            "telephone_number": "717-991-8750",
            "fax_number": "717-647-2106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIJU 5 DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-24",
        "last_updated": "2020-07-24",
        "certification_date": "2020-07-24",
        "status": "A",
        "authorized_official_last_name": "MOSS",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "ALLYN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "717-991-8750",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Susghuena Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John Forry Hinkle III, RPH
• John Forry Hinkle Jr., R.PH
• Hinkle'S Pharmacy
• Hinkle'S Pharmacy Inc
• Cheryl Hudson
• Janairo F. Hernandez,MD,PC
• John Martin Jensen Jr., DO
• John C Kepple, OD
• Johnson Hand Controls
• Tracy Ann Kellenberger, PA-C

• Dental Clinic/Center in Columbia, PA
• Providers in Columbia, PA by specialty
• Dental Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.