NPIMap

Organization Active NPI

Indiana Dental Clinic PC

Doing business as Atlanta Dental Clinic

  • General Practice Dentistry
  • Atlanta, IN
National Provider Identifier
1790888170
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
INDIANA DENTAL CLINIC PC
Doing business as
Atlanta Dental Clinic
Practice address
29101 St Rd 19
Atlanta, IN 46031
Phone
(765) 292-2366
Fax
(765) 292-2081
NPI assigned
Sep 7, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Fennis Bledsoe
Title
Chief Executive Officer
Phone
(765) 292-2366

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

29101 St Rd 19
Atlanta, IN 46031

Mailing address

PO Box 186
Atlanta, IN 46031
Phone (765) 292-2366

Other names 1

  • Atlanta Dental Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Atlanta Dental Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790888170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 186",
            "city": "ATLANTA",
            "state": "IN",
            "postal_code": "46031",
            "telephone_number": "765-292-2366",
            "fax_number": "765-292-2081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29101 ST RD 19",
            "city": "ATLANTA",
            "state": "IN",
            "postal_code": "46031",
            "telephone_number": "765-292-2366",
            "fax_number": "765-292-2081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA DENTAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLEDSOE",
        "authorized_official_first_name": "FENNIS",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "765-292-2366",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atlanta Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlanta, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.