Gary Lee Bacon, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

12009447A Issued in IN

Practice address

316 Washington Pointe Drive
Indianapolis, IN 46229

Phone

(317) 897-1147

Fax

(317) 897-1286

NPI assigned

May 2, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gary L. Bacon D.D.S., P.C.

  • Dental Clinic/Center
  • Indianapolis, IN
  • NPI 1023263845
  Authorized official Same address or phone

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386865558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 WASHINGTON POINTE DRIVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46229",
            "telephone_number": "317-897-1147",
            "fax_number": "317-897-1286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 WASHINGTON POINTE DRIVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46229",
            "telephone_number": "317-897-1147",
            "fax_number": "317-897-1286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "GARY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12009447A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morgan Leah Backes, OTR
• Kevin M Backfish, MD
• Sougandhi Backhaus, PHD
• Haydee Backing, MD
• Benjamin Scott Bacon, MD
• Starr Bacon
• Veronica Bacon
• Bacsa Dental PC (Emerson Avenue Detnal)
• Tim Bacsa, DDS
• Brent Taylor Bacus

• Dentist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.