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PERIODONTAL ASSOCIATES OF SOUTH BEND
NPI 1962078642
Dentist - Periodontics in South Bend, IN

Active since June 02, 2021
1918 EDISON RD, SOUTH BEND, IN 46617(574) 287-8900 Get Directions Write a Review

NPPES record last updated: June 2, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Periodontal Associates Of South Bend NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PERIODONTAL ASSOCIATES OF SOUTH BEND (NPI 1962078642) is a healthcare organization registered as a periodontics in South Bend, Indiana and active in the NPI registry since June 2021. The organization lists Gloria Royer, Practice Manager, as its authorized official.

NPPES Registry Identity

NPI1962078642
Entity TypeOrganization
Primary Taxonomy1223P0300X
Legal Business NamePERIODONTAL ASSOCIATES OF SOUTH BEND
Location Address1918 EDISON RDSouth Bend, IN 46617-1711
Mailing Address1918 Edison RdSouth Bend, IN 46617-1711 · (574) 287-8900
Phone(574) 287-8900
Organization SubpartNo
Authorized OfficialGloria RoyerPractice Manager · (765) 447-9319
Enumeration DateJune 2, 2021
NPPES CertifiedJune 2, 2021
✔ NPI 1962078642 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers
Taxonomy Code1223P0300X
Definition
That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.
1918 EDISON RD, South Bend, IN 46617
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Other Names 1

Doing Business AsPeriodontal Associates Of South Bend

Other Identifiers 1

Other12013130AIN · Dental License

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. PAUL A. SERGIO D.D.S.
Dentist (Periodontics)
1918 EDISON RD
SOUTH BEND, IN 46617
St. Joseph County (574) 287-8900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Periodontal Associates Of South Bend's NPI number?

The NPI number for Periodontal Associates Of South Bend is 1962078642. It was assigned to this organization in the NPPES registry on June 2, 2021.

Where is Periodontal Associates Of South Bend located?

Periodontal Associates Of South Bend is located at 1918 Edison Rd, South Bend, IN 46617. The listed phone number is (574) 287-8900.

What is Periodontal Associates Of South Bend's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

When was this NPI record last updated?

The NPPES record for Periodontal Associates Of South Bend was last updated on June 2, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.