Indiana Dental Associates

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

INDIANA DENTAL ASSOCIATES

Practice address

1901 Grant St
Gary, IN 46404-2761

Phone

(219) 880-1430

Fax

(219) 239-2197

NPI assigned

Dec 4, 2023

Organization subpart

No

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

Authorized official

Name

Lucia Gamino

Title

General Manager

Phone

(773) 530-7550

Specialties & licenses 1

Addresses

Practitioners 1

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

• Trinoda G Radcliffe, D.D.S.

  • General Practice Dentistry
  • Gary, IN
  • NPI 1912030826
  NPD (past)

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

{
    "created_epoch": "1701648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701648000000",
    "number": "1548037278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 E 93RD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606173607",
            "telephone_number": "773-530-7550",
            "fax_number": "773-530-0287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 GRANT ST",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464042761",
            "telephone_number": "219-880-1430",
            "fax_number": "219-239-2197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-04",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A",
        "authorized_official_last_name": "GAMINO",
        "authorized_official_first_name": "LUCIA",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "773-530-7550"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Huston, CADAC II, LAC
• Raquel Ibarra
• Tajudeen Tunde Idris, CASE MANAGER
• Ig Health & Vitality
• In Golden Hands
• Indiana Family Medical Supply LLC
• Indiana Medical Transportation Profession, LLC
• Indiana Medical Transportation Profession, LLC
• Indiana Regional Sleep Disorders Center, Inc
• Indiana University Northwest

• General Practice Dentistry in Gary, IN
• Providers in Gary, 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 Dec 4, 2023; 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.