South Bend Family Dentistry, P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12010453A Issued in IN

Legal business name

SOUTH BEND FAMILY DENTISTRY, P.C.

Practice address

1637 Portage Ave
South Bend, IN 46616-1743

Phone

(574) 233-8444

Fax

(574) 233-8366

NPI assigned

Nov 7, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Trang Khanh Mai, D.D.S.NPI 1104995885

Title

President

Phone

(574) 233-8444

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Trang Khanh Mai, D.D.S.

  • General Practice Dentistry
  • South Bend, IN
  • NPI 1104995885
  NPD (past) Authorized official

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401148800000",
    "number": "1841369535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1637 PORTAGE AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466161743",
            "telephone_number": "574-233-8444",
            "fax_number": "574-233-8366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1637 PORTAGE AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466161743",
            "telephone_number": "574-233-8444",
            "fax_number": "574-233-8366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BEND FAMILY DENTISTRY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2014-05-27",
        "status": "A",
        "authorized_official_last_name": "MAI",
        "authorized_official_first_name": "TRANG",
        "authorized_official_middle_name": "KHANH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "574-233-8444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010453A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200390950A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Bend Behavioral Health LLC
• South Bend Childrens Dentistry PC
• South Bend Community School Corporation
• South Bend Emergency Physicians, Inc
• South Bend Ergonomics, LLC
• South Bend in Endoscopy ASC LLC
• South Bend in Endoscopy ASC LLC
• South Bend Medical Foundation, Inc
• South Bend Medical Foundation, Inc
• South Bend Neurology, Inc.

• General Practice Dentistry in South Bend, IN
• Providers in South Bend, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2014; 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.