Active NPI
Candace Jane Rich, DDS
- Dentist
- South Bend, IN
National Provider Identifier
1699241216
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12009776A
- Practice address
- 220 Dean Johnson Blvd RM 184
South Bend, IN 46601-3415 - Phone
- (888) 489-5463
- NPI assigned
- Oct 22, 2018
- Last updated
- Oct 22, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12009776A | IN | Primary |
Addresses
Primary practice location
220 Dean Johnson Blvd RM 184
South Bend, IN 46601-3415
Mailing address
2246 S Paxton Dr
Warsaw, IN 46580-6404
Phone (574) 267-6571
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12009776A | IN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540166400000",
"number": "1699241216",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2246 S PAXTON DR",
"city": "WARSAW",
"state": "IN",
"postal_code": "465806404",
"telephone_number": "574-267-6571"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 DEAN JOHNSON BLVD RM 184",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466013415",
"telephone_number": "888-489-5463"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICH",
"first_name": "CANDACE",
"middle_name": "JANE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-22",
"last_updated": "2018-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12009776A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.