Individual provider Active NPI

D Richard McBride

  • General Practice Dentistry
  • Indianapolis, IN
National Provider Identifier
1649207267
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12008234A Issued in IN
Practice address
5430 E Washington St
Indianapolis, IN 46219-6449
Phone
(317) 322-1840
NPI assigned
Jun 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 12008234A IN Primary

Addresses

Primary practice location

5430 E Washington St
Indianapolis, IN 46219-6449

Mailing address

415 N Grand Ave
Pueblo, CO 81003-3111
Phone (719) 546-3333

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
I20160614001648 IN Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 2466743927

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12008234AINMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649207267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 N GRAND AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810033111",
            "telephone_number": "719-546-3333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5430 E WASHINGTON ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462196449",
            "telephone_number": "317-322-1840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCBRIDE",
        "first_name": "D",
        "middle_name": "RICHARD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12008234A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.