Individual provider Active NPI

Bryan M Vibeto, DDS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Minot, ND
National Provider Identifier
1053385468
Registry record updated Jul 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
1979 Issued in ND
Practice address
2615 Elk Dr
Ste 2
Minot, ND 58701-0001
Phone
(701) 839-6010
NPI assigned
Feb 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 11516 MN
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 1979 ND Primary

Addresses

Primary practice location

2615 Elk Dr
Ste 2
Minot, ND 58701-0001

Mailing address

2615 Elk Dr Ste 2
Minot, ND 58701-1200
Phone (701) 839-6010

Other identifiers 1

IdentifierTypeStateIssuer
41460MedicaidND

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
1979NDMDOrthodontics and Dentofacial Orthopedic Dentist
11516MNMDPrimary Care Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216166400000",
    "number": "1053385468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2615 ELK DR STE 2",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587011200",
            "telephone_number": "701-839-6010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 ELK DR",
            "address_2": "STE 2",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587010001",
            "telephone_number": "701-839-6010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIBETO",
        "first_name": "BRYAN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2008-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MN",
            "license": "11516",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "ND",
            "license": "1979",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41460",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minot, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.