Mini Dental Implant Centers of America LLC

Primary specialty

DentistTaxonomy code 122300000X

License

12007237 Issued in IN

Legal business name

MINI DENTAL IMPLANT CENTERS OF AMERICA LLC

Practice address

2001 S Tiger Drive
Yorktown, IN 47396

Phone

(765) 759-8351

Fax

(765) 759-8749

NPI assigned

Apr 24, 2012

Organization subpart

Yes

Parent organization

YORKTOWN FAMILY DENTISTRY INCAs reported in NPPES

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

Authorized official

Name

Stephen J Gant, DDS

Title

Dentist

Phone

(765) 759-8351

Specialties & licenses 1

Addresses

Part of

Yorktown Family Dentistry

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Yorktown Family Dentistry

  • Dental Clinic/Center
  • Yorktown, IN
  • NPI 1427212257
  NPPES parent name

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

{
    "created_epoch": "1335225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335225600000",
    "number": "1699033944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 S TIGER DRIVE",
            "city": "YORKTOWN",
            "state": "IN",
            "postal_code": "47396",
            "telephone_number": "765-759-8351",
            "fax_number": "765-759-8749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S TIGER DRIVE",
            "city": "YORKTOWN",
            "state": "IN",
            "postal_code": "47396",
            "telephone_number": "765-759-8351",
            "fax_number": "765-759-8749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINI DENTAL IMPLANT CENTERS OF AMERICA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "YORKTOWN FAMILY DENTISTRY INC",
        "enumeration_date": "2012-04-24",
        "last_updated": "2012-04-24",
        "status": "A",
        "authorized_official_last_name": "GANT",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "765-759-8351",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12007237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Yorktown, IN
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2012; 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.