Active NPI
Raymond Anthony Shelko, D.D.S.
- General Practice Dentistry
- Taos, NM
National Provider Identifier
1053442483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8722
- Practice address
- 1090 Goat Springs Road
Taos, NM 87571-1946 - Phone
- (575) 758-4224
- Fax
- (575) 751-5210
- NPI assigned
- Mar 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 | 8722 | GA | Primary |
Addresses
Primary practice location
1090 Goat Springs Road
Taos, NM 87571-1946
Mailing address
1090 Goat Springs Road
Taos, NM 87571-1946
Phone (575) 758-4224
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| K3543 | Medicaid | NM | |
| 49382861 | Medicaid | NM |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 8722 | GA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362096000000",
"number": "1053442483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1090 GOAT SPRINGS ROAD",
"city": "TAOS",
"state": "NM",
"postal_code": "875711946",
"telephone_number": "575-758-4224",
"fax_number": "575-751-5210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1090 GOAT SPRINGS ROAD",
"city": "TAOS",
"state": "NM",
"postal_code": "875711946",
"telephone_number": "575-758-4224",
"fax_number": "575-751-5210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHELKO",
"first_name": "RAYMOND",
"middle_name": "ANTHONY",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-08",
"last_updated": "2013-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "8722",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "K3543",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "49382861",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Taos, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.