Active NPI
Amy Evans, DMD
- General Practice Dentistry
- Carmel, IN
National Provider Identifier
1619065992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12010149
- Practice address
- 11711 N Pennsylvania St
Suite 114
Carmel, IN 46032-6959 - Phone
- (317) 816-0841
- Fax
- (317) 816-0859
- NPI assigned
- Oct 11, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12010149 | IN | Primary |
Addresses
Primary practice location
11711 N Pennsylvania St
Suite 114
Carmel, IN 46032-6959
Mailing address
11711 N Pennsylvania St
Suite 114
Carmel, IN 46032-6959
Phone (317) 816-0841
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12010149 | IN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Image Dental | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619065992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11711 N PENNSYLVANIA ST",
"address_2": "SUITE 114",
"city": "CARMEL",
"state": "IN",
"postal_code": "460326959",
"telephone_number": "317-816-0841",
"fax_number": "317-816-0859"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11711 N PENNSYLVANIA ST",
"address_2": "SUITE 114",
"city": "CARMEL",
"state": "IN",
"postal_code": "460326959",
"telephone_number": "317-816-0841",
"fax_number": "317-816-0859"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "AMY",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IN",
"license": "12010149",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carmel, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.