South Bend Smiles Youth Dentistry, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SOUTH BEND SMILES YOUTH DENTISTRY, LLC

Practice address

2332 Miracle LN
Mishawaka, IN 46545-3012

Phone

(574) 259-5437

Fax

(574) 259-5438

NPI assigned

May 24, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Jenell Stump

Title

Manager, Licensing & Credentialing

Phone

(615) 750-0343

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 4

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

• Lisa R Dekker-Reed, DDS

  • Dentist
  • South Bend, IN
  • NPI 1730322876

  General Practice

  NPD (past)
• Claudette Umurerwa Munyabera, DDS

  • Pediatric Dentistry
  • Mishawaka, IN
  • NPI 1093090318
  NPD (past)
• Rekha Rethiyamma, DMD

  • General Practice Dentistry
  • Mishawaka, IN
  • NPI 1730461203
  NPD (past)
• Manpreet Kaur Randhawa, DDS

  • Dentist
  • Dinuba, CA
  • NPI 1891041349

  General Practice

  NPD (past)

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404864000000",
    "number": "1902017593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 ARCADE UNIT 198747",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372191994",
            "telephone_number": "615-750-0343",
            "fax_number": "615-986-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2332 MIRACLE LN",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453012",
            "telephone_number": "574-259-5437",
            "fax_number": "574-259-5438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BEND SMILES YOUTH DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2014-07-09",
        "status": "A",
        "authorized_official_last_name": "STUMP",
        "authorized_official_first_name": "JENELL",
        "authorized_official_title_or_position": "MANAGER, LICENSING & CREDENTIALING",
        "authorized_official_telephone_number": "615-750-0343",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200828710A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902017593",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Phillip Sonnenburg, O.D.
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• Adrianna Soper, DO
• Sound Physicians of Indiana, LLC
• South Bend Mental Health Associates, PC
• Southerncare, Inc.
• Jennifer Spaid
• Michael Wendell Spalding, D.D.S.
• Colleen M Spano
• David Peter Speach, M.D.

• General Practice Dentistry in Mishawaka, IN
• Providers in Mishawaka, 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 Jul 9, 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.