Crown Hill Dentistry LLC – Dentist in Clinton, IN

Key facts

NPI: 1699115253
Entity type: Organization (NPI type 2)
Primary specialty: Dentist 122300000X
License: 12006928A (IN)
Legal business name: CROWN HILL DENTISTRY LLC
Practice address: 1792 E State Highway 163
Clinton, IN 47842-0160
Phone: (765) 832-7741
Fax: (765) 832-7743
NPI assigned: Jun 27, 2013
Organization subpart: No

Authorized official

Name: Dr. George Thomas Cloyd, DDS
Title: Managing Partner
Phone: (765) 832-7741

National Provider Directory

Locations

1792 E State Road 163
Clinton, IN 47842
Phone (765) 828-3241

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dentist Group: 193400000X SINGLE SPECIALTY GROUP	122300000X	12006928A	IN	Yes

Addresses

Primary practice location

1792 E State Highway 163
Clinton, IN 47842-0160

Mailing address

1792 E State Road 163
PO Box 408
Clinton, IN 47842-7327
Phone (765) 832-7741

Other identifiers

Identifier	Type	State	Issuer
1002436440A	Medicaid	IN

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 27, 2013.

{
    "created_epoch": "1372291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372291200000",
    "number": "1699115253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1792 E STATE ROAD 163",
            "address_2": "PO BOX 408",
            "city": "CLINTON",
            "state": "IN",
            "postal_code": "478427327",
            "telephone_number": "765-832-7741",
            "fax_number": "765-832-7743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1792 E STATE HIGHWAY 163",
            "city": "CLINTON",
            "state": "IN",
            "postal_code": "478420160",
            "telephone_number": "765-832-7741",
            "fax_number": "765-832-7743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROWN HILL DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-27",
        "last_updated": "2013-06-27",
        "status": "A",
        "authorized_official_last_name": "CLOYD",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "765-832-7741",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12006928A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1002436440A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, IN

All providers in Clinton, IN · Dentist in Indiana

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2013. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.