NPIMap

Organization Active NPI

Dental Professionals of in, P.C.

Doing business as Park 100 Dental Care

  • General Practice Dentistry
  • Indianapolis, IN
National Provider Identifier
1770194698
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONALS OF IN, P.C.
Doing business as
Park 100 Dental Care
Practice address
8570 Northwest Blvd
Indianapolis, IN 46278-1383
Phone
(317) 608-5692
NPI assigned
Aug 13, 2020
Last updated
Dec 10, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF IN, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

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

Authorized official

Name
Tabatha Lemke
Title
Credentialing Coordinator
Phone
(217) 540-6078

Specialties & licenses 1

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

Addresses

Primary practice location

8570 Northwest Blvd
Indianapolis, IN 46278-1383

Mailing address

8570 Northwest Blvd
Indianapolis, IN 46278-1383

Other names 1

  • Park 100 Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Professionals of in PC48 organizations share this tax ID, including this one
Part of
Dental Professionals of in PC

Other organizations with this tax ID 47

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

View all 47

Locations

8570 Northwest Blvd
Indianapolis, IN 46278
Phone (317) 291-8957

NPI Registry JSON

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

{
    "created_epoch": "1597276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733788800000",
    "number": "1770194698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8570 NORTHWEST BLVD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462781383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8570 NORTHWEST BLVD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462781383",
            "telephone_number": "317-608-5692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF IN, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF IN, P.C.",
        "enumeration_date": "2020-08-13",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A",
        "authorized_official_last_name": "LEMKE",
        "authorized_official_first_name": "TABATHA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-6078"
    },
    "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": "Park 100 Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; 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.