NPIMap

Organization Active NPI

Elkhart Dental Center PC

  • Customized Equipment (DME)
  • Elkhart, IN
National Provider Identifier
1962875286
Registry record updated Jan 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
License
12009361 Issued in IN
Legal business name
ELKHART DENTAL CENTER PC
Practice address
125 S Nappanee St
Elkhart, IN 46514-1967
Phone
(574) 522-0156
Fax
(574) 294-1407
NPI assigned
Nov 9, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2017

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

Authorized official

Name
Sue Lubarsky
Title
Office Manager
Phone
(574) 522-0156

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 12009361 IN
Customized Equipment (DME) 332BC3200X 12009361 IN Primary

Addresses

Primary practice location

125 S Nappanee St
Elkhart, IN 46514-1967

Mailing address

125 S Nappanee St
Elkhart, IN 46514-1967
Phone (574) 522-0156

National Provider Directory

National Provider Directory

Locations

125 S Nappanee St
Elkhart, IN 46514
Phone (574) 522-0156

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1447027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484092800000",
    "number": "1962875286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 S NAPPANEE ST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465141967",
            "telephone_number": "574-522-0156",
            "fax_number": "574-294-1407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 S NAPPANEE ST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465141967",
            "telephone_number": "574-522-0156",
            "fax_number": "574-294-1407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELKHART DENTAL CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-09",
        "last_updated": "2017-01-11",
        "status": "A",
        "authorized_official_last_name": "LUBARSKY",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "574-522-0156"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12009361",
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "IN",
            "license": "12009361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkhart, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2017; 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.