NPIMap

Organization Active NPI

Danville Dental Clinic, PC

  • General Practice Dentistry
  • Danville, IN
National Provider Identifier
1811022924
Registry record updated Sep 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12009222A Issued in IN
Legal business name
DANVILLE DENTAL CLINIC, PC
Practice address
2166 E Main St
Danville, IN 46122-9082
Phone
(317) 745-7711
Fax
(317) 745-1744
NPI assigned
Feb 22, 2007
Last updated
Sep 2, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2009

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

Authorized official

Name
Michael Clark BeatyNPI 1437109915
Title
President
Phone
(317) 745-7711

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 12010827A IN
General Practice Dentistry 1223G0001X 12006829A IN
General Practice Dentistry 1223G0001X 12009222A IN Primary

Addresses

Primary practice location

2166 E Main St
Danville, IN 46122-9082

Mailing address

2166 E Main St
Danville, IN 46122-9082
Phone (317) 745-7711

Other identifiers 2

IdentifierTypeStateIssuer
100133940AMedicaidIN
0000607321OtherINUNITED CONCORDIA

National Provider Directory

National Provider Directory

Locations

2166 E Main St
Danville, IN 46122
Phone (317) 745-7711

Practitioners & affiliated clinicians

Practitioners 2

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": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251849600000",
    "number": "1811022924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2166 E MAIN ST",
            "city": "DANVILLE",
            "state": "IN",
            "postal_code": "461229082",
            "telephone_number": "317-745-7711",
            "fax_number": "317-745-1744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2166 E MAIN ST",
            "city": "DANVILLE",
            "state": "IN",
            "postal_code": "461229082",
            "telephone_number": "317-745-7711",
            "fax_number": "317-745-1744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANVILLE DENTAL CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2009-09-02",
        "status": "A",
        "authorized_official_last_name": "BEATY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "CLARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "317-745-7711"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010827A",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12006829A",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12009222A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100133940A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "0000607321",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2009; 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.