NPIMap

Organization Active NPI

Fremont Family Dentistry, P.C.

  • General Practice Dentistry
  • Fremont, IN
National Provider Identifier
1871715359
Registry record updated May 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
012537445 001 7 Issued in IN
Legal business name
FREMONT FAMILY DENTISTRY, P.C.
Practice address
1003 W Toledo Street
Fremont, IN 46737-0667
Phone
(260) 495-2255
Fax
(260) 495-9023
NPI assigned
May 3, 2007
Last updated
May 17, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2016

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

Authorized official

Name
Mrs. Susan H. Mauk, D.D.SNPI 1801809421
Title
President
Phone
(260) 495-2255

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 012537445 001 7 IN Primary

Addresses

Primary practice location

1003 W Toledo Street
Fremont, IN 46737-0667

Mailing address

P.O. Box 667
Fremont, IN 46737-0667
Phone (260) 495-2255

National Provider Directory

National Provider Directory

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": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463443200000",
    "number": "1871715359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 667",
            "city": "FREMONT",
            "state": "IN",
            "postal_code": "467370667",
            "telephone_number": "260-495-2255",
            "fax_number": "260-495-9023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 W TOLEDO STREET",
            "city": "FREMONT",
            "state": "IN",
            "postal_code": "467370667",
            "telephone_number": "260-495-2255",
            "fax_number": "260-495-9023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREMONT FAMILY DENTISTRY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2016-05-17",
        "status": "A",
        "authorized_official_last_name": "MAUK",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-495-2255",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "012537445 001 7",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2016; 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.