Courtney Bumbaugh, DDS
Individual provider Active NPI Dentist · Columbia City, IN
NPI 1740700210 · NPPES record last updated Jan 6, 2020
Key facts
- NPI
- 1740700210
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 12012735A (IN)
- Practice address
- 510 N Main St
Columbia City, IN 46725-1314 - Phone
- (260) 212-5058
- Fax
- (260) 232-0053
- NPI assigned
- Jun 26, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12012735A | IN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Still Waters Family Dentistry, PC | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12012735A | IN | Yes |
Addresses
Primary practice location
510 N Main St
Columbia City, IN 46725-1314
Mailing address
1202 S 500 E
Columbia City, IN 46725-9049
Other practice location 1
10045 N State Road 1
Ossian, IN 46777-9781
Phone (260) 622-4138
Other practice location 2
3505 N State Road 15 Ste A
Warsaw, IN 46582
Phone (574) 269-1199
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 46725 | Other | ZIP |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | dr.courtney@smilesonmaincc.com |
Other providers in Columbia City, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 6, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.