Mark Robert Detert, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

7849 Issued in IN

Practice address

919 South State Road 2
Hebron, IN 46341-9539

Phone

(219) 996-4171

NPI assigned

Mar 19, 2007

Last updated

Jul 8, 2007By 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 1

Addresses

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

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912021585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 SOUTH STATE ROAD 2",
            "city": "HEBRON",
            "state": "IN",
            "postal_code": "463419539",
            "telephone_number": "219-996-4171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 SOUTH STATE ROAD 2",
            "city": "HEBRON",
            "state": "IN",
            "postal_code": "463419539",
            "telephone_number": "219-996-4171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETERT",
        "first_name": "MARK",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "7849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter J Blank, D.D.S.
• Carla K Brink, D.D.S.
• Kiera Faith Brummet
• Carla K. Brink, D.D.S., P.C.
• Dedicated Family Health
• Brianna R Dettman, PHARMD
• Edward Erb
• Erma J Galvin, MSW
• Christina Lynn Gohsman
• Sarah Elizabeth Gorski, ATC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.