Murray Diner

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

016.0002044 Issued in VT

Practice address

53 Main St
Richford, VT 05476-1151

Phone

(802) 848-3829

Fax

(802) 848-3849

NPI assigned

Dec 7, 2005

Last updated

Jun 10, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• James V. Wyllie, DDS P.C.

  • General Practice Dentistry
  • Newport, VT
  • NPI 1760695597
  NPD (past)
• The Richford Health Center Inc

  dba NOTCH Primary Care

  • Federally Qualified Health Center (FQHC)
  • Saint Albans, VT
  • NPI 1306592613
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433894400000",
    "number": "1023093606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 PROUTY DRIVE",
            "address_2": "SUITE 1",
            "city": "NEWPORT",
            "state": "VT",
            "postal_code": "05855",
            "telephone_number": "802-334-6965",
            "fax_number": "802-334-6606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 MAIN ST",
            "city": "RICHFORD",
            "state": "VT",
            "postal_code": "054761151",
            "telephone_number": "802-848-3829",
            "fax_number": "802-848-3849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DINER",
        "first_name": "MURRAY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2015-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "VT",
            "license": "016.0002044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1006289",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rosaire W Bisson, PA
• Autumn M Bondesen, PA
• Nathan A Bouchard, D.D.S.
• Nathaniel Burns, PA-C
• Abigail Anne Debay, PA
• Ioannis Yannis Felemegos, M.D.
• William Allen Green, DMD
• Emily Jean Grims
• Edward A Haak, DO
• David Francis Jette, DDS

• Pediatric Dentistry in Richford, VT
• Providers in Richford, VT by specialty
• Pediatric Dentistry in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.