SELECT DENTAL ASSOCIATES PC (NPI# 1457850687) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457850687 |
| Entity Type | Organization |
| Organization Name | SELECT DENTAL ASSOCIATES PC |
| Practice Address |
1422 Lincoln Way E South Bend IN 46613-3250 |
| Practice Telephone | 5742328888 |
| Practice Fax Number | 5742328929 |
| Mailing Telephone | 5742328888 |
| Mailing Fax Number | 5742328929 |
| Enumeration Date | 2018-02-02 |
| Last Update Date | 2018-02-02 |
| Authorized Official Name | DOUGLAS J KOSEK (OWNER) |
| Authorized Official Telephone | 5743403423 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
12009873 | IN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | STATE LICENSE | 12010354A | 01 |
| IN | 200214390 | 05 | |
| IN | STATE LICENSE | 12012866A | 01 |
| Street Address |
1422 LINCOLN WAY E |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46613-3250 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457345688 | David M. Follis | Dentist | 1422 Lincoln Way E, South Bend, IN 46613-3250 | 2005-09-02 |
| 1811186323 | Select Dentistry, PC | Dentist | 1422 Lincoln Way E, South Bend, IN 46613-3250 | 2007-10-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730330721 | Mindy Lynne Gradeless | Social Worker | 229 East Ewing Avenue, South Bend, IN 46613 | 2008-10-08 |
| 1689836405 | Staci-marie Balog Norman | Pharmacist | 760 West Cotter Street, South Bend, IN 46613 | 2008-07-02 |
| 1659386779 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1945 Lincolnway East, South Bend, IN 46613 | 2006-07-29 |
| 1003026642 | Logan Community Resources, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2105 Wabash St, South Bend, IN 46613-1138 | 2007-05-23 |
| 1366702060 | Clara M Davis | Private Vehicle | 1719 W Dubail St, South Bend, IN 46613-1216 | 2012-05-29 |
| 1215923313 | Gregory Matthew Ferro | Family Medicine | 1832 Prairie Ave, South Bend, IN 46613-1400 | 2005-09-23 |
| 1508330002 | Homeworks Construction Inc | Durable Medical Equipment & Medical Supplies | 1511 Pulaski St, South Bend, IN 46613-1404 | 2019-01-17 |
| 1477763415 | Logan Community Resources, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1917 S Walnut St, South Bend, IN 46613-1541 | 2007-05-22 |
| 1013117472 | Ronald E Grow Inc | Family Medicine | 810 W Indiana Ave, South Bend, IN 46613-1828 | 2007-07-23 |
| 1437444692 | Life Treatment Centers | Substance Abuse Rehabilitation Facility | 1402 S Michigan St, South Bend, IN 46613-2214 | 2011-06-16 |
| Find all providers in zip 46613 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| 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. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871116673 | Chelsea Ann Myers | Dentist | 206 W Ireland Rd, South Bend, IN 46614-2506 | 2020-05-27 |
| 1437644549 | Modupe Mary Ogunnusi Sofuye | Dentist | 1290 E Ireland Rd, South Bend, IN 46614-3474 | 2018-06-30 |
| 1508020066 | Gerald Warrell | Dentist | 2314 Miami St, South Bend, IN 46614-1336 | 2008-07-14 |
| 1619144672 | James Alvin Douglas | Dentist | 820 E Colfax Ave, South Bend, IN 46617-2804 | 2008-05-09 |
| 1962670208 | Paul Michael Mcleod | Dentist | 919 E Jefferson Blvd Ste Ll02, South Bend, IN 46617-3119 | 2008-02-20 |
| 1447428248 | Daniel Frederick Lindborg | Dentist | 52303 Emmons Road, Suite 17, South Bend, IN 46637-4294 | 2008-02-14 |
| 1275701369 | Geoffrey A. Klopenstine Dds PC | Dentist | 51584 Us Highway 33, South Bend, IN 46637-1704 | 2008-02-12 |
| 1659581007 | Philip Paul Hulecki | Dentist | 3608 Pleasant St, South Bend, IN 46615-2033 | 2007-05-23 |
| 1891917282 | Lifetime Dental Careof Indiana, PC | Dentist | 1605 North Ironwood, South Bend, IN 46635 | 2007-05-03 |
| 1780704247 | Douglas John Kosek | Dentist | 413 W Jefferson Blvd, South Bend, IN 46601-1514 | 2007-03-29 |
| Find all providers in SOUTH BEND | ||||
| City | SOUTH BEND |
| Zip Code | 46613 |
Please comment or provide details below to improve the information on SELECT DENTAL ASSOCIATES PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.