Brittany Carol Eirwin-Maqueda, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12011855A Issued in IN

Practice address

3430 W State Road 66
Rockport, IN 47635-9259

Phone

(812) 649-4416

NPI assigned

Jul 10, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Reo Family Dental

  • General Practice Dentistry
  • Rockport, IN
  • NPI 1417407644
  NPD (past) Authorized official

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

{
    "created_epoch": "1341878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352332800000",
    "number": "1841555463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3430 WEST STATE ROAD 66",
            "city": "ROCKPORT",
            "state": "IN",
            "postal_code": "476359259",
            "telephone_number": "812-649-4416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3430 W STATE ROAD 66",
            "city": "ROCKPORT",
            "state": "IN",
            "postal_code": "476359259",
            "telephone_number": "812-649-4416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EIRWIN-MAQUEDA",
        "first_name": "BRITTANY",
        "middle_name": "CAROL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-10",
        "last_updated": "2012-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12011855A",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "9189",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201115460A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin Lloyd Davis, RPH
• Deaconess Clinic Inc.
• Deaconess Clinic, Inc.
• Deaconess Hospital, Inc
• Dr. C. Michael Wood
• Katrina J Erickson, M.D.
• Faulkenberg Harth Inc
• Kayla Hagan Fearon, PTA
• Corey Fortwendel, PHARMD
• G H Schumacher & Sons Inc

• General Practice Dentistry in Rockport, IN
• Providers in Rockport, 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 Nov 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.