Lisa R Dekker-Reed, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12011340 Issued in IN

Practice address

919 E Jefferson Blvd Ste 100
South Bend, IN 46617-3112

Phone

(574) 245-7501

Fax

(574) 245-7502

NPI assigned

Apr 17, 2009

Last updated

Sep 20, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Miracle Lane Family Dentistry P.C.

  • Dental Clinic/Center
  • Mishawaka, IN
  • NPI 1093122418
  NPD (past)
• South Bend Smiles Youth Dentistry, LLC

  • General Practice Dentistry
  • Mishawaka, IN
  • NPI 1902017593
  NPD (past)

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

{
    "created_epoch": "1239926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695168000000",
    "number": "1730322876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 E JEFFERSON BLVD STE 100",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466173112",
            "telephone_number": "574-245-7501",
            "fax_number": "574-245-7502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 E JEFFERSON BLVD STE 100",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466173112",
            "telephone_number": "574-245-7501",
            "fax_number": "574-245-7502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEKKER-REED",
        "first_name": "LISA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-17",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12011340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kara Degard
• Mary T Degeneffe, MD
• Amanda Leigh Dehn, FNP-BC
• Gwendolyn C Dehorn, L.C.S.W
• Jane Ann Dejong, R.PH.
• Christal Lynn Delaruelle, RN
• Miranda Delaruelle
• Brooke Delay
• Henry W. Deleeuw, M.D.
• Paige Delfish, RBT

• Dentist in South Bend, IN
• Providers in South Bend, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.