BLACKBEAGLE DMD DDS MSD (NPI# 1801412564) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801412564 |
| Entity Type | Organization |
| Organization Name | BLACKBEAGLE DMD DDS MSD |
| Practice Address |
3003 E 98th St Ste 200 Indianapolis IN 46280-1973 |
| Practice Telephone | 3178431281 |
| Practice Fax Number | 3175749390 |
| Mailing Telephone | 3178431281 |
| Mailing Fax Number | 3175749390 |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2020-06-18 |
| Authorized Official Name | DR. RACHEL M BLACK (OWNER) |
| Authorized Official Telephone | 3178431281 |
| Authorized Official Credential | DMD MSD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers |
| Street Address |
3003 E 98TH ST STE 200 |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46280-1973 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427067289 | Jay R Beagle | Dentist | 3003 E 98th St Ste 200, Indianapolis, IN 46280-1973 | 2006-08-07 |
| 1588142020 | Rachel M Black | Dentist | 3003 E 98th St Ste 200, Indianapolis, IN 46280-1973 | 2018-08-06 |
| 1417408360 | Jason Kum | Dentist | 3003 E 98th St Ste 200, Indianapolis, IN 46280-1973 | 2016-10-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689273112 | Melissa Ramos Bauzo, LLC | Marriage & Family Therapist | 3021 E 98th Street, 110, Indianapolis, IN 46280 | 2020-10-26 |
| 1609240613 | Benjamin C Campbell | Ophthalmology | 201 Pennsylvania Pkwy Ste 225, Indianapolis, IN 46280 | 2015-11-15 |
| 1184872434 | Scott Alan Hartman | Physical Medicine & Rehabilitation | 3077 East 96th Street, 265, Indianapolis, IN 46280 | 2008-08-28 |
| 1528197381 | Indiana Developmental Training Center LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 11075 N Pennsylvania St, Indianapolis, IN 46280 | 2007-03-05 |
| 1780711515 | Dr Lynn Burford P C | Optometrist | 10485 N Pennsylvania, Indianapolis, IN 46280 | 2007-02-28 |
| 1992875868 | Lynn Burford | Optometrist | 10485 N. Pennsylvania, Indianapolis, IN 46280 | 2006-11-08 |
| 1790797694 | Fiona Jane Kress | Psychologist | 3021 E. 98th Street, Suite 180, Kress Psychological Services, LLC, Indianapolis, IN 46280 | 2006-08-12 |
| 1780178384 | Laboratory Corporation of America Holdings | Clinical Medical Laboratory | 201 Pennsylvania Pkwy Ste 200, Indianapolis, IN 46280 | 2018-06-18 |
| 1154709830 | Justin P Hawk | Physician Assistant | 201 Pennsylvania Pkwy Ste 100, Indianapolis, IN 46280 | 2015-05-13 |
| 1386059905 | Justin Stano | Internal Medicine | 201 Pennsylvania Pkwy, Indianapolis, IN 46280 | 2014-06-23 |
| Find all providers in zip 46280 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| 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. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609421965 | Hawra Alqallaf | Dentist | 1121 W Michigan St # Ds422, Indianapolis, IN 46202-5211 | 2019-08-05 |
| 1518470897 | Meridian Street Periodontics, LLC | Dentist | 8801 N Meridian St Ste 103, Indianapolis, IN 46260-2353 | 2017-11-09 |
| 1164726832 | Indy East Periodontics PC | Dentist | 115 N Shortridge Rd Ste 100, Indianapolis, IN 46219-4917 | 2011-01-10 |
| 1831316769 | Michael Kevin Gossweiler | Dentist | 7537 W 38th St, Indianapolis, IN 46254-2937 | 2007-04-20 |
| 1942358007 | Daniel Gomes | Dentist | 8235 Country Village Dr, Indianapolis, IN 46214 | 2007-01-08 |
| 1902963507 | Carl Lerner | Dentist | 8937 Southpointe Dr, Suite A-2, Indianapolis, IN 46227-1086 | 2007-01-02 |
| 1962561209 | John A Overman | Dentist | 3003 E 98th St Ste 241, Indianapolis, IN 46280-2907 | 2006-12-06 |
| 1790864445 | Stephen B Towns | Dentist | 508 Indiana Ave, Indianapolis, IN 46202-3106 | 2006-11-03 |
| 1295816007 | Kurt David Vanwinkle | Dentist | 8902 N Meridian St Ste 138, Indianapolis, IN 46260-5306 | 2006-10-18 |
| 1427067289 | Jay R Beagle | Dentist | 3003 E 98th St Ste 200, Indianapolis, IN 46280-1973 | 2006-08-07 |
| Find all providers in INDIANAPOLIS | ||||
| City | INDIANAPOLIS |
| Zip Code | 46280 |
Please comment or provide details below to improve the information on BLACKBEAGLE DMD DDS MSD.
| 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.