Alan Roy Antao, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

12014150A Issued in IN

Practice address

909 N Washington St
Bourbon, IN 46504-1447

Phone

(574) 342-4385

NPI assigned

Nov 17, 2010

Last updated

Sep 25, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Nicole L. Christy DDS PC

  dba Bourbon Family Dentistry

  • General Practice Dentistry
  • Bourbon, IN
  • NPI 1033274071
  NPD (past)

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

{
    "created_epoch": "1289952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1841592235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3136 WOODFIELD DR",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469024788",
            "telephone_number": "765-513-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 N WASHINGTON ST",
            "city": "BOURBON",
            "state": "IN",
            "postal_code": "465041447",
            "telephone_number": "574-342-4385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTAO",
        "first_name": "ALAN",
        "middle_name": "ROY",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-17",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN21372",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12014150A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Lynn Christy, D.D.S.
• Stephen F Cullison, D.D.S.
• Jennifer Robyn Friberg, N.P.
• JMRX, PC (Bourbon Pharmacy)
• Barbara Jane Kunnen, MS, RN, FNP-C

• Dentist in Bourbon, IN
• Providers in Bourbon, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; 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.