NPIMap

Organization Active NPI

Blue Tooth Dental Inc.

  • General Practice Dentistry
  • Evanston, WY
National Provider Identifier
1063664795
Registry record updated Oct 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
715 Issued in WY
Legal business name
BLUE TOOTH DENTAL INC.
Practice address
545 Cheyenne Dr
Suite C
Evanston, WY 82930-5323
Phone
(307) 789-9034
Fax
(307) 789-9065
NPI assigned
Oct 13, 2008
Last updated
Oct 13, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2008

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

Authorized official

Name
Mrs. Sherry Hancock
Title
Office Manager
Phone
(307) 789-9034

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 715 WY Primary

Addresses

Primary practice location

545 Cheyenne Dr
Suite C
Evanston, WY 82930-5323

Mailing address

545 Cheyenne Dr
Suite C
Evanston, WY 82930-5323
Phone (307) 789-9034

National Provider Directory

National Provider Directory

Locations

545 Cheyenne Dr
Ste C
Evanston, WY 82930
Phone (307) 789-9034

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1223856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223856000000",
    "number": "1063664795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 CHEYENNE DR",
            "address_2": "SUITE C",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829305323",
            "telephone_number": "307-789-9034",
            "fax_number": "307-789-9065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 CHEYENNE DR",
            "address_2": "SUITE C",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829305323",
            "telephone_number": "307-789-9034",
            "fax_number": "307-789-9065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE TOOTH DENTAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-13",
        "last_updated": "2008-10-13",
        "status": "A",
        "authorized_official_last_name": "HANCOCK",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "307-789-9034",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WY",
            "license": "715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 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.