Rekha Rethiyamma, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9108 Issued in KY

Practice address

2332 Miracle LN
Mishawaka, IN 46545-3012

Phone

(574) 259-5437

NPI assigned

Sep 12, 2011

Last updated

Sep 12, 2011By 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 KY

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": "1315785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315785600000",
    "number": "1730461203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W 8TH ST",
            "address_2": "SUITE 810",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810033038",
            "telephone_number": "719-562-4447",
            "fax_number": "719-583-1801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2332 MIRACLE LN",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453012",
            "telephone_number": "574-259-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RETHIYAMMA",
        "first_name": "REKHA",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-12",
        "last_updated": "2011-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "9108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haylee Marie Rella
• Brody Eelco Remble
• Andrew Renner, M.D.
• Holly Maye Renner
• Ariel Renae Rentfrow
• Stephanie Reynolds, MSW
• Thomas K Rhee, MD
• Kirstin P Rhinehart, OD
• Sarah R Rhodes, MS, LAT, ATC
• Troy Rhodes, O.D.

• General Practice Dentistry in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2011; 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.