Plymouth 20/20 Dental, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PLYMOUTH 20/20 DENTAL, LLC

Practice address

1409 N Michigan St
Plymouth, IN 46563-1119

Phone

(574) 936-8787

NPI assigned

Sep 21, 2016

Last updated

Sep 21, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

20/20 DENTAL, LLCAs reported in NPPES

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

Authorized official

Name

Dr. Ronald I Prokes, DDS

Title

Chief Financial Officer

Phone

(317) 601-6010

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1474416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474416000000",
    "number": "1689122491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 N MICHIGAN ST",
            "city": "PLYMOUTH",
            "state": "IN",
            "postal_code": "465631119",
            "telephone_number": "574-936-8787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 N MICHIGAN ST",
            "city": "PLYMOUTH",
            "state": "IN",
            "postal_code": "465631119",
            "telephone_number": "574-936-8787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLYMOUTH 20/20 DENTAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "20/20 DENTAL, LLC",
        "enumeration_date": "2016-09-21",
        "last_updated": "2016-09-21",
        "status": "A",
        "authorized_official_last_name": "PROKES",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "317-601-6010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Perry
• Timothy A Peters, M.D.
• Brian L Piazza, M.D.
• Aubree Pittman
• Louis D. Plumlee, D.D.S.
• Plymouth Community School Corporation
• Plymouth Eye Clinic, P.C. (Plymouth Family Eyecare)
• Plymouth Family Dental Care
• Plymouth Family Dentistry, Inc
• Plymouth Fire & EMS Department (Plymouth Community Ambulance Service)

• General Practice Dentistry in Plymouth, IN
• Providers in Plymouth, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 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.