Active NPI
Devin Brant Shone, D.D.S.
- Pediatric Dentistry
- Bloomington, IN
National Provider Identifier
1740628619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 12012040A
- Practice address
- 477 S Landmark Ave
Bloomington, IN 47403-5005 - Phone
- (812) 355-0855
- NPI assigned
- Jun 12, 2013
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 12012040A | IN | Primary |
Addresses
Primary practice location
477 S Landmark Ave
Bloomington, IN 47403-5005
Mailing address
4743 Pearcrest Way
Greenwood, IN 46143-7803
Phone (765) 524-0216
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 |
|---|---|---|---|
| 12012040A | IN | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bloomington Pediatric Dentistry L.L.C. | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Dentistry
- Bloomington, IN
- NPI 1780850628
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435708800000",
"number": "1740628619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4743 PEARCREST WAY",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461437803",
"telephone_number": "765-524-0216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "477 S LANDMARK AVE",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474035005",
"telephone_number": "812-355-0855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHONE",
"first_name": "DEVIN",
"middle_name": "BRANT",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-06-12",
"last_updated": "2015-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "IN",
"license": "12012040A",
"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 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.