Dr J Pediatric Dentistry LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

12012166A Issued in IN

Legal business name

DR J PEDIATRIC DENTISTRY LLC

Practice address

10820 Pendleton Pike Ste B
Indianapolis, IN 46236-2952

Phone

(317) 938-1181

NPI assigned

Aug 11, 2016

Organization subpart

No

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

Authorized official

Name

Juan Fernando Yepes, DDS

Title

Pediatric Dentist

Phone

(317) 938-1181

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1470873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470873600000",
    "number": "1629522289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10820 PENDLETON PIKE STE B",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462362952",
            "telephone_number": "317-938-1181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10820 PENDLETON PIKE STE B",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462362952",
            "telephone_number": "317-938-1181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR J PEDIATRIC DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-11",
        "last_updated": "2016-08-11",
        "status": "A",
        "authorized_official_last_name": "YEPES",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "FERNANDO",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "317-938-1181",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IN",
            "license": "12012166A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60003191",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Dental Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2016; 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.