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INDIANA UNIVERSITY NORTHWEST NPI 1912067349


NPI Information

NPI: 1912067349
Provider Name: INDIANA UNIVERSITY NORTHWEST
Classification: Dentist - 1223D0001X
Entity Type: Organization

Specialization: Dental Public Health

CLIA Number: 15D1091157

Address:
3400 BROADWAY
GARY, IN
ZIP 46408
Phone: (219) 980-6772
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INDIANA UNIVERSITY NORTHWEST is a dental public health dentist in Gary, IN. The provider is the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice that serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis. INDIANA UNIVERSITY NORTHWEST NPI is 1912067349. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3400 BROADWAY
GARY, IN
ZIP 46408-101
Phone: (219) 980-6772

The provider's authorized official is Cindy Zak .
The authorized official title is Clinic Manager and has the following contact phone number (219) 980-6772.

The CLIA number assigned to this NPI record is 15D1091157 - school/student health service with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/8/2006 and was last updated on 7/21/2022.


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
11223D0001XDentistDental Public Health0INDIANAYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1200082120MEDICAIDINDIANA

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: 5/5/2024

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