Lake Park Dental Group

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

LAKE PARK DENTAL GROUP

Practice address

7855 Grand Blvd
Hobart, IN 46342-6665

Phone

(219) 942-4473

NPI assigned

Jun 14, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Marcus William Malczewski, DDSNPI 1386764157

Title

President

Phone

(219) 942-4473

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Marcus William Malczewski, DDS

  • Dentist
  • Hobart, IN
  • NPI 1386764157
  NPD Authorized official
• Nicholas Anthony Howard, D.D.S.

  • General Practice Dentistry
  • Hobart, IN
  • NPI 1114307873
  NPD (past)

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

{
    "created_epoch": "1655164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655164800000",
    "number": "1396475257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7855 GRAND BLVD",
            "city": "HOBART",
            "state": "IN",
            "postal_code": "463426665",
            "telephone_number": "219-942-4473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7855 GRAND BLVD",
            "city": "HOBART",
            "state": "IN",
            "postal_code": "463426665",
            "telephone_number": "219-942-4473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE PARK DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-14",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A",
        "authorized_official_last_name": "MALCZEWSKI",
        "authorized_official_first_name": "MARCUS",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-942-4473",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary P Kustron
• Fadee Kutom, MD
• Labcorp Indiana Inc
• Laboratory Corporation of America Holdings
• Lake Park Clinic, P.C.
• Lake Park Surgicare, LLC
• Lakeshore Anesthesia, P.C.
• Mariah Landeros, RBT
• Mary Latham
• Lauren W. Harting MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; 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.