Active NPI
Brandon John Tilts, DDS
- Dentist
- Flagstaff, AZ
National Provider Identifier
1073709366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 7686
- Practice address
- 518 N Beaver St
Suite a
Flagstaff, AZ 86001-3020 - Phone
- (928) 774-4705
- Fax
- (928) 213-9665
- NPI assigned
- Sep 20, 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 7686 | AZ | Primary |
Addresses
Primary practice location
518 N Beaver St
Suite a
Flagstaff, AZ 86001-3020
Mailing address
3505 W Lead Rope
Flagstaff, AZ 86001-2302
Phone (928) 637-5354
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151013000164 | AZ | Order and Referring Only - Dentist | 1052620119 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7686 | AZ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Timberline Dental PLLC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Flagstaff, AZ
- NPI 1861711608
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332720000000",
"number": "1073709366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3505 W LEAD ROPE",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860012302",
"telephone_number": "928-637-5354"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "518 N BEAVER ST",
"address_2": "SUITE A",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860013020",
"telephone_number": "928-774-4705",
"fax_number": "928-213-9665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILTS",
"first_name": "BRANDON",
"middle_name": "JOHN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-20",
"last_updated": "2012-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "7686",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flagstaff, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2012; 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.