Mishawaka Dental LLC

Primary specialty

DentistTaxonomy code 122300000X

License

12012619A Issued in IN

Legal business name

MISHAWAKA DENTAL LLC

Practice address

4170 Grape Rd
Mishawaka, IN 46545-2610

Phone

(574) 272-4200

NPI assigned

Jan 3, 2017

Organization subpart

No

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

Authorized official

Name

Heather Kraushaar

Title

PSR

Phone

(315) 454-6000

Specialties & licenses 1

Addresses

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tarnit Singh Kapoor

  • Dentist
  • Mishawaka, IN
  • NPI 1700269388
  NPD (past)
• Jennifer Coronado Losier, D.D.S.

  • Dentist
  • Fort Wayne, IN
  • NPI 1588926125
  NPD (past)
• Kelly Cathryn Terranova, DDS

  • General Practice Dentistry
  • Mishawaka, IN
  • NPI 1801028766
  NPD (past)
• Chelsea Ann Griebe, DDS

  • General Practice Dentistry
  • Richmond, MI
  • NPI 1871116673
  NPD (past)

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

{
    "created_epoch": "1483401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483401600000",
    "number": "1730624529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3189",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132203189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4170 GRAPE RD",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465452610",
            "telephone_number": "574-272-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISHAWAKA DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-03",
        "last_updated": "2017-01-03",
        "status": "A",
        "authorized_official_last_name": "KRAUSHAAR",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "PSR",
        "authorized_official_telephone_number": "315-454-6000"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12012619A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Perry Minner Jr., LCSW
• Miracle Homecare LLC (Miracle homecare)
• Miracle Lane Family Dentistry P.C.
• Pedro A Miro, MD
• Mishawaka Clinic, P.C.
• Mishawaka Family Pharmacy LLC (Mishawaka Family Pharmacy)
• Mishawaka Il/Al, LLC
• Mishawaka Medical Arts Pharmacy
• Mishawaka Orthopedics and Sports Medicine P C
• Mishawaka Osteopathic Clinic

• Dentist in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.