Active NPI
Robert Wayne Iveson III, DDS
- Dentist
- Coldwater, MI
National Provider Identifier
1003346453
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901022205
- Practice address
- 382 E Chicago St
Coldwater, MI 49036-2062 - Phone
- (517) 278-7269
- NPI assigned
- Jun 18, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901022205 | MI | Primary |
Addresses
Primary practice location
382 E Chicago St
Coldwater, MI 49036-2062
Mailing address
382 E Chicago St
Coldwater, MI 49036-2062
Phone (517) 812-9280
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901022205 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543968000000",
"number": "1003346453",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "382 E CHICAGO ST",
"city": "COLDWATER",
"state": "MI",
"postal_code": "490362062",
"telephone_number": "517-812-9280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "382 E CHICAGO ST",
"city": "COLDWATER",
"state": "MI",
"postal_code": "490362062",
"telephone_number": "517-278-7269"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVESON",
"first_name": "ROBERT",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-18",
"last_updated": "2018-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901022205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coldwater, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.