NPIMap

Organization Active NPI

Decatur Dental Services

Doing business as Geneva Dental Clinic

  • General Practice Dentistry
  • Geneva, IN
National Provider Identifier
1760559082
Registry record updated Mar 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12010412 Issued in IN
Legal business name
DECATUR DENTAL SERVICES
Doing business as
Geneva Dental Clinic
Practice address
447 E Line St
Geneva, IN 46740-8936
Phone
(260) 368-7500
Fax
(260) 368-7167
NPI assigned
Nov 30, 2006
Last updated
Mar 31, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2025

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

Authorized official

Name
Dr. David C Baker
Title
Dentist
Phone
(260) 368-7500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 12010412 IN Primary

Addresses

Primary practice location

447 E Line St
Geneva, IN 46740-8936

Mailing address

447 E Line St
Geneva, IN 46740-8936
Phone (260) 368-7500

Other identifiers 3

IdentifierTypeStateIssuer
200355500MedicaidIN
300080654MedicaidIN
100146810MedicaidIN

Other names 1

  • Geneva Dental Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Decatur Dental Services5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743379200000",
    "number": "1760559082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "447 E LINE ST",
            "city": "GENEVA",
            "state": "IN",
            "postal_code": "467408936",
            "telephone_number": "260-368-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "447 E LINE ST",
            "city": "GENEVA",
            "state": "IN",
            "postal_code": "467408936",
            "telephone_number": "260-368-7500",
            "fax_number": "260-368-7167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECATUR DENTAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2025-03-31",
        "certification_date": "2025-03-31",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "260-368-7500",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010412",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200355500",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300080654",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100146810",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Geneva Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Geneva, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2025; 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.