Organization Active NPI

University Park Dental Associates

  • Dental Clinic/Center
  • South Bend, IN
National Provider Identifier
1356113690
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
UNIVERSITY PARK DENTAL ASSOCIATES
Practice address
16597 State Road 23
South Bend, IN 46635-1461
Phone
(574) 272-4441
NPI assigned
Oct 30, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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

Authorized official

Name
Opal Anderson
Title
Manager
Phone
(574) 272-4441

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

16597 State Road 23
South Bend, IN 46635-1461

Mailing address

16597 State Road 23
South Bend, IN 46635-1461

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1698624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698624000000",
    "number": "1356113690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16597 STATE ROAD 23",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16597 STATE ROAD 23",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351461",
            "telephone_number": "574-272-4441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY PARK DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-30",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-29",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "OPAL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "574-272-4441"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; 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.