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UNIVERSITY PARK FAMILY DENTISTRY LLC NPI 1508248360


NPI Information

NPI: 1508248360
Provider Name: UNIVERSITY PARK FAMILY DENTISTRY, LLC
Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
16597 STATE ROAD 23
SOUTH BEND, IN
ZIP 46635
Phone: (574) 272-4441
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UNIVERSITY PARK FAMILY DENTISTRY, LLC is a general practice dentist in South Bend, IN. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. UNIVERSITY PARK FAMILY DENTISTRY, LLC NPI is 1508248360. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

16597 STATE ROAD 23
SOUTH BEND, IN
ZIP 46635-461
Phone: (574) 272-4441
Fax: (574) 968-0689

The provider's authorized official is Jeffrey Allen Turner .
The authorized official title is Owner and has the following contact phone number (574) 272-4441.

The enumeration date for this NPI number is 6/29/2015 and was last updated on 6/29/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223G0001XDentistGeneral Practice120092272INDIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1200261730MEDICAIDINDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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