NPIMap

Organization Active NPI

Adoni Dental PC

  • General Practice Dentistry
  • Mishawaka, IN
National Provider Identifier
1356586382
Registry record updated Dec 4, 2008
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Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12011100A Issued in IN
Legal business name
ADONI DENTAL PC
Practice address
4170 Grape Rd
Mishawaka, IN 46545-2610
Phone
(574) 272-4200
NPI assigned
Dec 4, 2008
Last updated
Dec 4, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2008

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

Authorized official

Name
Dr. Samuel Wakim, DDS
Title
Owner
Phone
(574) 272-4200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 12011100A IN Primary

Addresses

Primary practice location

4170 Grape Rd
Mishawaka, IN 46545-2610

Mailing address

PO Box 3189
Syracuse, NY 13220-3189
Phone (315) 454-6000

National Provider Directory

National Provider Directory

Locations

4170 Grape Rd
Mishawaka, IN 46545
Phone (574) 272-4200

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1228348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228348800000",
    "number": "1356586382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3189",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132203189",
            "telephone_number": "315-454-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4170 GRAPE RD",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465452610",
            "telephone_number": "574-272-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADONI DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-04",
        "last_updated": "2008-12-04",
        "status": "A",
        "authorized_official_last_name": "WAKIM",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "574-272-4200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12011100A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2008; 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.