LAURA KUKELHAN, DDS
Complete NPI Record 1003001710
Dentist - General Practice in Bluffton, IN

NPI Status: Active since September 06, 2007

Contact Information

1133 N MAIN ST
BLUFFTON, IN
ZIP 46714
Phone: (260) 824-3100
Fax: (260) 824-0018

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Complete NPI Dataset

The following table represents the complete dataset for NPI number 1003001710. The table includes a list of all field names, values and definitions of the full NPI record. This dataset is available for download in CSV format using the "Download NPI" button below at the end of the table.

Name Value Definition
NPI1003001710The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameCOMPLETE SMILES, INC.The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization NameLAURA KUKELHAN, DDSOther name by which the organization provider is or has been known.
Provider Other Organization Name Type Code3Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address1133 N MAIN STThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City NameBLUFFTONThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameINThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code467141324The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number2608243100The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number2608240018The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address1133 N MAIN STThe first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameBLUFFTONThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameINThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code467141324The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number2608243100The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number2608240018The fax number associated with the location address of the provider being identified.
Provider Enumeration Date9/6/2007The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date9/6/2007The date that a record was last updated or changed.
Authorized Official Last NameRUNYONThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameVIKKIThe first name of the authorized official.
Authorized Official Middle NameS.The middle name of the authorized official.
Authorized Official Title or PositionSECRETARYThe title or position of the authorized official.
Authorized Official Telephone Number2608243100The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 11223G0001XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 112010786The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1INThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1Y
Is Organization SubpartN
Healthcare Provider Taxonomy Group 1193400000X SINGLE SPECIALTY GROUP