NPIMap

Organization Active NPI

Goshen Cosmetic and Advanced Family Dentistry PC

  • General Practice Dentistry
  • Goshen, IN
National Provider Identifier
1356562631
Registry record updated Jul 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
GOSHEN COSMETIC AND ADVANCED FAMILY DENTISTRY PC
Practice address
1801 Charlton CT
Goshen, IN 46526-6464
Phone
(574) 533-8934
Fax
(574) 533-9487
NPI assigned
May 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2017

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

Authorized official

Name
Dr. Chad G. Stutsman, DDSNPI 1710108030
Title
Owner
Phone
(574) 533-8934

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1801 Charlton CT
Goshen, IN 46526-6464

Mailing address

1801 Charlton CT
Goshen, IN 46526-6464
Phone (574) 533-8934

Other names 1

  • Stutsman Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

1801 Charlton Ct
Goshen, IN 46526
Phone (574) 533-8934

Practitioners & affiliated clinicians

Practitioners 3

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": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499644800000",
    "number": "1356562631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 CHARLTON CT",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465266464",
            "telephone_number": "574-533-8934",
            "fax_number": "574-533-9487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 CHARLTON CT",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465266464",
            "telephone_number": "574-533-8934",
            "fax_number": "574-533-9487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOSHEN COSMETIC AND ADVANCED FAMILY DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2017-07-10",
        "status": "A",
        "authorized_official_last_name": "STUTSMAN",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "574-533-8934",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stutsman Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Stutsman Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Goshen, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2017; 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.