Advanced Dental Care of Anderson LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ADVANCED DENTAL CARE OF ANDERSON LLC

Practice address

1612 E 53Rd St
Anderson, IN 46013-2826

Phone

(765) 622-7000

NPI assigned

Jun 12, 2019

Last updated

Jul 9, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jack Summerlin III, DDS

Title

Owner

Phone

(317) 409-8819

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1560297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562630400000",
    "number": "1952960916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11333 MIRADOR LN",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460378687",
            "telephone_number": "317-409-8819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1612 E 53RD ST",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460132826",
            "telephone_number": "765-622-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DENTAL CARE OF ANDERSON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-12",
        "last_updated": "2019-07-09",
        "status": "A",
        "authorized_official_last_name": "SUMMERLIN",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-409-8819",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Advanced Dental Care of Anderson LLC
• Advanced Family Dentistry of Anderson
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• Aegis Group Practice LLC
• George Agapios, MD

• General Practice Dentistry in Anderson, IN
• Providers in Anderson, 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, 2019; 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.