NPI Record of GRANGER FAMILY DENTISTRY, PC NPI 1619072147

Dentist (General Practice) in Granger, IN

Complete NPI Record

Field Name Value Definition
NPI1619072147The 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 NameGRANGER FAMILY DENTISTRY, PCThe name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address12545 ADAMS RDThe 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 NameGRANGERThe 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 Code465309226The 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 Number5742775406The 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 Number5742775467The 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 Address12545 ADAMS RDThe 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 NameGRANGERThe 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 Code465309226The 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 Number5742775406The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number5742775467The fax number associated with the location address of the provider being identified.
Provider Enumeration Date9/13/2006The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date9/14/2020The date that a record was last updated or changed.
Authorized Official Last NameANGLEMIREThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameTHOMASThe first name of the authorized official.
Authorized Official Middle NameJOHNThe middle name of the authorized official.
Authorized Official Title or PositionOWNER / PRESIDENTThe title or position of the authorized official.
Authorized Official Telephone Number5742775406The 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 112009209BThe 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 1N
Healthcare Provider Taxonomy Code 21223G0001X
Provider License Number 212007958BThe 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 2INThe 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 2Y
Is Organization SubpartN
Authorized Official Name Prefix TextMR.
Authorized Official Credential TextD.D.S.
Healthcare Provider Taxonomy Group 1193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2193400000X MULTIPLE SINGLE SPECIALTY GROUP
NPI Certification Date9/14/2020