Childrens Dental Specialist

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

12007455A Issued in IN

Legal business name

CHILDRENS DENTAL SPECIALIST

Practice address

803 W Gardner Dr
Marion, IN 46952-1819

Phone

(765) 664-0587

NPI assigned

Jan 15, 2018

Organization subpart

No

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

Authorized official

Name

Alice M. Butterworth, D.D.S

Title

Owner

Phone

(765) 664-0587

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1515974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515974400000",
    "number": "1598273393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 W GARDNER DR",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469521819",
            "telephone_number": "765-664-0587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 W GARDNER DR",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469521819",
            "telephone_number": "765-664-0587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDRENS DENTAL SPECIALIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-15",
        "last_updated": "2018-01-15",
        "status": "A",
        "authorized_official_last_name": "BUTTERWORTH",
        "authorized_official_first_name": "ALICE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "765-664-0587",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IN",
            "license": "12007455A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 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.