Pediatric Dental Associates of Indiana, Inc

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PEDIATRIC DENTAL ASSOCIATES OF INDIANA, INC

Practice address

2100 45TH St
Highland, IN 46322-3742

Phone

(219) 924-4411

Fax

(219) 924-2314

NPI assigned

Oct 10, 2006

Last updated

Sep 1, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Carl Joseph Tyree, DDSNPI 1780772665

Title

Owner

Phone

(219) 924-4411

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carl Joseph Tyree, DDS

  • Pediatric Dentistry
  • Highland, IN
  • NPI 1780772665
  Authorized official Same address or phone

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661990400000",
    "number": "1679661565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 45TH ST",
            "city": "HIGHLAND",
            "state": "IN",
            "postal_code": "463223742",
            "telephone_number": "219-924-4411",
            "fax_number": "219-924-2314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 45TH ST",
            "city": "HIGHLAND",
            "state": "IN",
            "postal_code": "463223742",
            "telephone_number": "219-924-4411",
            "fax_number": "219-924-2314"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Wall St",
            "address_purpose": "LOCATION",
            "city": "Valparaiso",
            "state": "IN",
            "postal_code": "463832564",
            "country_code": "US",
            "telephone_number": "219-462-6337",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL ASSOCIATES OF INDIANA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2022-09-01",
        "certification_date": "2022-09-01",
        "status": "A",
        "authorized_official_last_name": "TYREE",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "219-924-4411",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100208100",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sanjay C Patel
• Paun Family Chiropractic and Wellness, PC
• Joseph James Paun, MS, DC
• Sarah Rhea Paun, D.C.
• Tammy A Pavlowski, P.T.
• Pediatric Dentistry of Northwest Indiana PC
• Pediatric Healthcare Associates
• Weng Peng, MD
• Jordan W. Pickens
• Lorraine Alexa Pickett

• Pediatric Dentistry in Highland, IN
• Providers in Highland, IN by specialty
• Pediatric Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2022; 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.