Ryan David Tschetter, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12010765A Issued in IN

Practice address

1124 S College Mall Rd
Bloomington, IN 47401

Phone

(812) 336-5525

Fax

(812) 332-5520

NPI assigned

Oct 16, 2006

Last updated

May 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Jackson Creek Dental

  • Dentist
  • Bloomington, IN
  • NPI 1114362803
  NPD (past) Authorized official
• Jackson Creek Dental

  • General Practice Dentistry
  • Bloomington, IN
  • NPI 1295062339
  NPD (past)

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526515200000",
    "number": "1457431629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 S COLLEGE MALL RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474016178",
            "telephone_number": "812-336-5525",
            "fax_number": "812-332-5520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 S COLLEGE MALL RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "47401",
            "telephone_number": "812-336-5525",
            "fax_number": "812-332-5520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TSCHETTER",
        "first_name": "RYAN",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2018-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12010765A",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010765A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200974140A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Trpkovski, D.O.
• True North LLC
• Kyle A True, D.C.
• Eric Trueblood, M.D.
• Jacqueline S. Trueblood, M.D.
• Vanessa Gisela Tseng, MD
• Melissa A Tsirtsis, DPT
• Alexis Tucker, RBT
• Cassie D Tucker, RBT
• Micaela Tucker, RBT

• General Practice Dentistry in Bloomington, IN
• Providers in Bloomington, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; 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.