Decatur Family Dentistry 2.0

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DECATUR FAMILY DENTISTRY 2.0

Practice address

1020 Southampton Dr
Decatur, IN 46733-1049

Phone

(260) 223-7533

NPI assigned

Apr 15, 2025

Last updated

Apr 22, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Forrest Fullenkamp, DDSNPI 1730733007

Title

Owner

Phone

(260) 223-7533

Specialties & licenses 1

Addresses

Other names 1

• Decatur Family Dentistry Other name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Forrest Wane Fullenkamp, DDS

  • Dentist
  • Decatur, IN
  • NPI 1730733007
  NPD Authorized official

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

{
    "created_epoch": "1744675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745280000000",
    "number": "1548056922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 SOUTHAMPTON DR",
            "city": "DECATUR",
            "state": "IN",
            "postal_code": "467331049",
            "telephone_number": "260-223-7533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 SOUTHAMPTON DR",
            "city": "DECATUR",
            "state": "IN",
            "postal_code": "467331049",
            "telephone_number": "260-223-7533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECATUR FAMILY DENTISTRY 2.0",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-15",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A",
        "authorized_official_last_name": "FULLENKAMP",
        "authorized_official_first_name": "FORREST",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-223-7533",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Decatur Family Dentistry",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Decatur Family Dentistry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Teresa Ann Conrad, PT
• Robert Michael Corral, M. ED, CSAYC
• Chelsea Crago, LSW
• Vera A Cummins, N.P.
• Decatur Dental Services, Inc.
• Decatur Family Dentistry of Adams County LLC (Decatur Family Dentistry)
• Decatur Fire Department
• Decatur Urgent Care Walk in Clinic LLC
• Alberto Jose Delgado, M.D.
• Regan Renee Dettmer, PHARMD

• General Practice Dentistry in Decatur, IN
• Providers in Decatur, 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 Apr 22, 2025; 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.