Periodontal Specialists of Indiana, PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

PERIODONTAL SPECIALISTS OF INDIANA, PC

Practice address

9660 E 146TH St
Suite 500
Noblesville, IN 46060-3099

Phone

(317) 774-0716

Fax

(317) 774-0720

NPI assigned

Mar 23, 2007

Organization subpart

No

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

Authorized official

Name

Burton Largura, DDS, MSD

Title

Dentist

Phone

(317) 774-0716

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1952428344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9660 E 146TH ST",
            "address_2": "SUITE 500",
            "city": "NOBLESVILLE",
            "state": "IN",
            "postal_code": "460603099",
            "telephone_number": "317-774-0716",
            "fax_number": "317-774-0720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9660 E 146TH ST",
            "address_2": "SUITE 500",
            "city": "NOBLESVILLE",
            "state": "IN",
            "postal_code": "460603099",
            "telephone_number": "317-774-0716",
            "fax_number": "317-774-0720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTAL SPECIALISTS OF INDIANA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LARGURA",
        "authorized_official_first_name": "BURTON",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "317-774-0716",
        "authorized_official_credential": "DDS, MSD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.