Eastern Indiana Pediatric Dentistry, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

12006522B Issued in IN

Legal business name

EASTERN INDIANA PEDIATRIC DENTISTRY, LLC

Practice address

724 N Grand Ave
Connersville, IN 47331-2015

Phone

(765) 825-2051

NPI assigned

May 13, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Charles Poland III, DDS

Title

Member

Phone

(317) 566-8183

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• John Randall Roberts, D.D.S.

  • General Practice Dentistry
  • Connersville, IN
  • NPI 1285799395
  NPD (past)

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

{
    "created_epoch": "1242172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242172800000",
    "number": "1760616114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 SUMMERLAKES CT",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460329392",
            "telephone_number": "317-566-8183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "724 N GRAND AVE",
            "city": "CONNERSVILLE",
            "state": "IN",
            "postal_code": "473312015",
            "telephone_number": "765-825-2051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN INDIANA PEDIATRIC DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-13",
        "last_updated": "2009-05-13",
        "status": "A",
        "authorized_official_last_name": "POLAND",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "317-566-8183",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IN",
            "license": "12006522B",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mikayla Dougherty
• Dr. Brian J. Altman & Associates, P.C.
• Dr. Tom Christie Family Dentistry PC
• Bradley M Dubois, MD
• James Lowell Dunn, RPH
• Sue Carol Ellis, SLP
• Haelynn Ervine
• Ess of Connersville, LLC
• Everton Volunteer Fire Department Incorporated
• Eye Center Group LLC

• Pediatric Dentistry in Connersville, IN
• Providers in Connersville, IN by specialty
• Pediatric Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2009; 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.