NPIMap

Organization Active NPI

Lighthouse Dental

  • Dentist
  • Plymouth, IN
National Provider Identifier
1861410318
Registry record updated Nov 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12009200 Issued in IN
Legal business name
LIGHTHOUSE DENTAL
Practice address
556 N Oak Rd
Plymouth, IN 46563-1664
Phone
(574) 936-3921
Fax
(574) 936-1010
NPI assigned
Jul 17, 2006
Last updated
Nov 20, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2007

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

Authorized official

Name
Dr. Bruce F Becker, DDSNPI 1770745374
Title
President
Phone
(574) 936-3921

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 12009200 IN Primary

Addresses

Primary practice location

556 N Oak Rd
Plymouth, IN 46563-1664

Mailing address

556 N Oak Rd
Plymouth, IN 46563-1664
Phone (574) 936-3921

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195516800000",
    "number": "1861410318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "556 N OAK RD",
            "city": "PLYMOUTH",
            "state": "IN",
            "postal_code": "465631664",
            "telephone_number": "574-936-3921",
            "fax_number": "574-936-1010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "556 N OAK RD",
            "city": "PLYMOUTH",
            "state": "IN",
            "postal_code": "465631664",
            "telephone_number": "574-936-3921",
            "fax_number": "574-936-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2007-11-20",
        "status": "A",
        "authorized_official_last_name": "BECKER",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "574-936-3921",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12009200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; 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.