NPIMap

Individual provider Active NPI

Kelly Cathryn Terranova, DDS

  • General Practice Dentistry
  • Mishawaka, IN
National Provider Identifier
1801028766
Registry record updated Dec 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
64008 Issued in CA
Practice address
4170 Grape Rd
Mishawaka, IN 46545-2610
Phone
(574) 272-4200
Fax
(574) 255-5056
NPI assigned
Aug 11, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 64008 CA Primary

Addresses

Primary practice location

4170 Grape Rd
Mishawaka, IN 46545-2610

Mailing address

9850 Genesee Avenue
Suite 720
La Jolla, CA 92037
Phone (858) 453-5525

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Saade Terranova Dental Partnership General Practice CurrentSince Mar 21, 2021 Accepting new patients
Mishawaka Dental LLC Past Accepting new patients
Richard L. Sherman DDS, Inc. General Practice Past Accepting new patients
Adoni Dental PC General Practice Past Accepting new patients

Locations

9850 Genesee Ave
Ste 720
La Jolla, CA 92037
Phone (858) 453-5525

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1249948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482883200000",
    "number": "1801028766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9850 GENESEE AVENUE",
            "address_2": "SUITE 720",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "92037",
            "telephone_number": "858-453-5525",
            "fax_number": "858-453-1275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4170 GRAPE RD",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465452610",
            "telephone_number": "574-272-4200",
            "fax_number": "574-255-5056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERRANOVA",
        "first_name": "KELLY",
        "middle_name": "CATHRYN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-11",
        "last_updated": "2016-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "64008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2016; 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.