Richard Edward Zollinger, D.D.S. – Dentist

Key facts

NPI: 1508082272
Entity type: Individual (NPI type 1)
Primary specialty: Dentist 122300000X
License: 12008759 (IN)
Practice address: 230 E Whitley St # 265
Churubusco, IN 46723-1506
Phone: (260) 693-2177
Fax: (260) 693-6422
NPI assigned: Apr 18, 2007
Sex: Male
Sole proprietor: No

Organizations & group practices 2

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

Churubusco Family Dentistry, LLC Dental Clinic/Center · Churubusco, IN · NPI 1336310218

NPD (past)
Russell E. Gilliom, D.D.S., P.C. Dental Clinic/Center · Churubusco, IN · NPI 1902021827

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Enrolled in IN
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20161107001727	IN	Order and Referring Only - Dentist Practitioner - Dentist	8123307519

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
12008759	IN	MD	Dentist

Practice roles

Organization	Specialty	Status	New patients
Russell E. Gilliom, D.D.S., P.C.		Past	Accepting new patients
Churubusco Family Dentistry, LLC		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dentist	122300000X	12008759	IN	Yes

Addresses

Primary practice location

230 E Whitley St # 265
Churubusco, IN 46723-1506

Mailing address

3770 S Meridian Rd
Columbia City, IN 46725-9781
Phone (260) 248-2851

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 14, 2008.

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200268800000",
    "number": "1508082272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3770 S MERIDIAN RD",
            "city": "COLUMBIA CITY",
            "state": "IN",
            "postal_code": "467259781",
            "telephone_number": "260-248-2851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 E WHITLEY ST # 265",
            "city": "CHURUBUSCO",
            "state": "IN",
            "postal_code": "467231506",
            "telephone_number": "260-693-2177",
            "fax_number": "260-693-6422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZOLLINGER",
        "first_name": "RICHARD",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-18",
        "last_updated": "2008-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12008759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Churubusco, IN

All providers in Churubusco, IN · Dentist in Indiana

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 14, 2008. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.