NPIMap

Organization Active NPI

MFDC of Indiana, Inc

  • General Practice Dentistry
  • Bloomington, IN
National Provider Identifier
1760977367
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MFDC OF INDIANA, INC
Practice address
3617 W State Road 46
Bloomington, IN 47404-9152
Phone
(812) 876-0007
Fax
(812) 876-0014
NPI assigned
Jun 26, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

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

Authorized official

Name
Jeff Reibel
Title
CFP
Phone
(502) 254-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

3617 W State Road 46
Bloomington, IN 47404-9152

Mailing address

PO Box 437169
Louisville, KY 40253-7169

Other names 1

  • Gentle Dentist - Elletsville Doing business as

National Provider Directory

National Provider Directory
Tax ID family
MFDC of Indiana Inc19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1529971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1760977367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 437169",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402537169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3617 W STATE ROAD 46",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474049152",
            "telephone_number": "812-876-0007",
            "fax_number": "812-876-0014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MFDC OF INDIANA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-26",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "REIBEL",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CFP",
        "authorized_official_telephone_number": "502-254-8500"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gentle Dentist - Elletsville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 6, 2023; 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.