Berea Family Dental

Primary specialty

DentistTaxonomy code 122300000X

License

15902 Issued in OH

Legal business name

BEREA FAMILY DENTAL

Practice address

20 S Limestone St
Suite110
Springfield, OH 45502-2219

Phone

(937) 322-7832

NPI assigned

Apr 3, 2015

Last updated

Apr 3, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kathy Nelson

Title

Practice Administrator

Phone

(937) 206-4080

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

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.

• Mark R Bedford, D.D.S.

  • General Practice Dentistry
  • Berea, OH
  • NPI 1780691352
  NPD (past)

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

{
    "created_epoch": "1428019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428019200000",
    "number": "1780079038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "359 FRONT ST",
            "city": "BEREA",
            "state": "OH",
            "postal_code": "440171760",
            "telephone_number": "440-234-2813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 S LIMESTONE ST",
            "address_2": "SUITE110",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455022219",
            "telephone_number": "937-322-7832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEREA FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-03",
        "last_updated": "2015-04-03",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "937-206-4080"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "15902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2809232",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0431321",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Marie Bennett, COTA/L
• Samantha Bennett
• Kelly A Bennington, PA
• Amanda Bensman
• Kaylie Rose Benson, MSN, APRN-CNP
• Jackson Berger
• Susan Berger, CNP
• Jared Berner
• Scout Berner
• Kaylor Re'Shawn Berry

• Dentist in Springfield, OH
• Providers in Springfield, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2015; 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.