NPIMap

Organization Active NPI

German Church Rd Family Dentistry

  • General Practice Dentistry
  • Indianapolis, IN
National Provider Identifier
1386067627
Registry record updated Jan 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12007959A Issued in IN
Legal business name
GERMAN CHURCH RD FAMILY DENTISTRY
Practice address
11020 E 10TH St Ste a
Indianapolis, IN 46229-3710
Phone
(317) 898-9231
Fax
(317) 898-9245
NPI assigned
Jan 22, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2014

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

Authorized official

Name
Diane Coombs
Title
Office Manager
Phone
(317) 898-9231

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 12007959A IN Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 120111490A IN

Addresses

Primary practice location

11020 E 10TH St Ste a
Indianapolis, IN 46229-3710

Mailing address

11020 E 10TH St Ste a
Indianapolis, IN 46229-3710
Phone (317) 898-9231

Other identifiers 1

IdentifierTypeStateIssuer
100065700AMedicaidIN

National Provider Directory

National Provider Directory

Locations

11020 E 10th St
#A
Indianapolis, IN 46229
Phone (317) 898-9231

Practitioners & affiliated clinicians

Practitioners 2

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": "1390348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390348800000",
    "number": "1386067627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11020 E 10TH ST STE A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462293710",
            "telephone_number": "317-898-9231",
            "fax_number": "317-898-9245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11020 E 10TH ST STE A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462293710",
            "telephone_number": "317-898-9231",
            "fax_number": "317-898-9245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERMAN CHURCH RD FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-22",
        "last_updated": "2014-01-22",
        "status": "A",
        "authorized_official_last_name": "COOMBS",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "317-898-9231"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12007959A",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "120111490A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100065700A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2014; 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.