Individual provider Active NPI

Bhavneet Singh

  • Dentist
  • Fort Wayne, IN
National Provider Identifier
1619351772
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12012395A Issued in IN
Practice address
6408 W Jefferson Blvd Ste D
Fort Wayne, IN 46804-6204
Phone
(347) 385-1488
NPI assigned
Jul 17, 2015
Last updated
Apr 16, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 12012395A IN Primary
Dentist 122300000X 2901600238 MI

Addresses

Primary practice location

6408 W Jefferson Blvd Ste D
Fort Wayne, IN 46804-6204

Mailing address

6408 W Jefferson Blvd Ste D
Fort Wayne, IN 46804-6204
Phone (347) 385-1488

Other practice location 1

4614 Coldwater Rd Ste F
Fort Wayne, IN 46825-5527
Phone (260) 666-5200

Other practice location 2

2880 Walmart Dr Unit 2920
Huntington, IN 46750-7977
Phone (260) 200-4100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150924000835 IN Order and Referring Only - DentistPractitioner - Dentist 8628386620

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12012395AINMDDentist
2901600238MIMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Marvel Dental DDS PC CurrentSince Mar 1, 2022 Accepting new patients
Familia Dental Fort Wayne PLLC Past Accepting new patients

Locations

4614 Coldwater Rd
Ste F
Fort Wayne, IN 46825
Phone (216) 801-2718

6408 W Jefferson Blvd
#D
Fort Wayne, IN 46804
Phone (216) 801-2718

2880 Walmart Dr
Unit 2920
Huntington, IN 46750
Phone (216) 801-2718

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713225600000",
    "number": "1619351772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6408 W JEFFERSON BLVD STE D",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046204",
            "telephone_number": "347-385-1488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6408 W JEFFERSON BLVD STE D",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046204",
            "telephone_number": "347-385-1488"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4614 Coldwater Rd Ste F",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468255527",
            "country_code": "US",
            "telephone_number": "260-666-5200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2880 Walmart Dr Unit 2920",
            "address_purpose": "LOCATION",
            "city": "Huntington",
            "state": "IN",
            "postal_code": "467507977",
            "country_code": "US",
            "telephone_number": "260-200-4100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SINGH",
        "first_name": "BHAVNEET",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-17",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12012395A",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901600238",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.