Active NPI
William John Sentiere, D.D.S.,M.S.D.
- Periodontics
- Bloomington, IN
National Provider Identifier
1730205121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 1200 8993
- Practice address
- 3925 Hagan St
204
Bloomington, IN 47401-8556 - Phone
- (812) 333-0358
- Fax
- (812) 333-8386
- NPI assigned
- Mar 21, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 1200 8993 | IN | Primary |
Addresses
Primary practice location
3925 Hagan St
204
Bloomington, IN 47401-8556
Mailing address
3925 Hagan St
204
Bloomington, IN 47401-8556
Phone (812) 333-0358
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 |
|---|---|---|---|
| 1200 8993 | IN | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730205121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3925 HAGAN ST",
"address_2": "204",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474018556",
"telephone_number": "812-333-0358",
"fax_number": "812-333-8386"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3925 HAGAN ST",
"address_2": "204",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474018556",
"telephone_number": "812-333-0358",
"fax_number": "812-333-8386"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SENTIERE",
"first_name": "WILLIAM",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "D.D.S.,M.S.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IN",
"license": "1200 8993",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.