The Portland Dental Place

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12010271A Issued in IN

Legal business name

THE PORTLAND DENTAL PLACE

Practice address

112 N Ship St
Portland, IN 47371-1844

Phone

(260) 726-4710

Fax

(260) 726-7051

NPI assigned

Dec 7, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Teresa M Watkins, DDS

Title

Dentist

Phone

(260) 726-4710

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1323216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323216000000",
    "number": "1982972790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 N SHIP ST",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "473711844",
            "telephone_number": "260-726-4710",
            "fax_number": "260-726-7051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 N SHIP ST",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "473711844",
            "telephone_number": "260-726-4710",
            "fax_number": "260-726-7051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PORTLAND DENTAL PLACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-07",
        "last_updated": "2011-12-07",
        "status": "A",
        "authorized_official_last_name": "WATKINS",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "260-726-4710",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010271A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200888510",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200962440",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abby N Strong, RNFA, NP
• Lauren Ashley Subler, PHARMD
• Mark Weiler Tatman, DDS
• The Eye Center Group LLC (Portland Eye Center)
• The Jay School Corporation
• Jamie Thobe
• Thomas M. Banta, D.D.S., PC
• Danielle Thompson
• Jonathon Treon
• Tricounty Surgical Assoc., PC

• General Practice Dentistry in Portland, IN
• Providers in Portland, 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 Dec 7, 2011; 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.