ST. JOHN PREMIER DENTAL NPI 1093633133

NPI Information

  • NPI: 1093633133
  • Provider Name: ST. JOHN PREMIER DENTAL
  • Classification: Dentist - 1223G0001X
  • Specialization: General Practice
  • Entity Type: Organization
  • Address: 10271 CALUMET AVE.
    #103
    ST. JOHN, IN
    ZIP 46373
  • Phone: (219) 627-7000

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NPI Details

ST. JOHN PREMIER DENTAL is a general practice dentist in St. John, 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. ST. JOHN PREMIER DENTAL NPI is 1093633133. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

10271 CALUMET AVE.
#103
ST. JOHN, IN
ZIP 46373
Phone: (219) 627-7000
Fax: (219) 627-9627

The provider's authorized official is Peter William Straka .
The authorized official title is Owner and has the following contact phone number (219) 627-7000.

The enumeration date for this NPI number is 7/7/2026 and was last updated on 7/7/2026.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral PracticeYes

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: 11/21/2025

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