Active NPI
Daron Paul Etie, DDS
- General Practice Dentistry
- Beaumont, TX
National Provider Identifier
1023114337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 17276
- Practice address
- 3853 Phelan Blvd
Beaumont, TX 77707 - Phone
- (409) 835-2415
- Fax
- (409) 835-7064
- NPI assigned
- Sep 15, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 17276 | TX | Primary |
Addresses
Primary practice location
3853 Phelan Blvd
Beaumont, TX 77707
Mailing address
3853 Phelan Blvd
Beaumont, TX 77707
Phone (409) 835-2415
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5798 | Other | NATIONAL PACIFIC DENTAL | |
| 831278 | Other | TX | UNITED CONCORDIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Sep 21, 2016 through Sep 21, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17276 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023114337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3853 PHELAN BLVD",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "77707",
"telephone_number": "409-835-2415",
"fax_number": "409-835-7064"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3853 PHELAN BLVD",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "77707",
"telephone_number": "409-835-2415",
"fax_number": "409-835-7064"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETIE",
"first_name": "DARON",
"middle_name": "PAUL",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "17276",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL PACIFIC DENTAL",
"identifier": "5798",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "831278",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaumont, TX
- Essex Brothers Management Co., L.L.C.
- Rose Anne Essex, RD
- Samuel Bryan Essex
- Essilor Laboratories of America, L.P. (Omni Optical)
- Jorge Ramiez Estemcdonald, PHARM.D
- Osarugue Sarah Etinfoh, PMHNP
- Etx Medical Group, PLLC (EastEx Urgent Care)
- Debbie Evans-Rogers, PT
- Keith Alan Evans, D.C.
- Melissa Ann Evans, FNP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.