Individual provider Active NPI

Vaughn W Teuscher, DDS

  • General Practice Dentistry
  • Vancouver, WA
National Provider Identifier
1104821289
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE00006502 Issued in WA
Practice address
2415 SE 165TH Ave
Ste 102
Vancouver, WA 98683-4324
Phone
(360) 256-1202
Fax
(360) 885-3580
NPI assigned
Jun 16, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DE00006502 WA Primary

Addresses

Primary practice location

2415 SE 165TH Ave
Ste 102
Vancouver, WA 98683-4324

Mailing address

2415 SE 165TH Ave
Ste 102
Vancouver, WA 98683-4324
Phone (360) 256-1202

Other identifiers 3

IdentifierTypeStateIssuer
5017140MedicaidWA
56502OtherWAWASHINGTON DENTAL SERVICE
146076OtherWADEPT. OF L&I

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160512001368 WA Order and Referring Only - DentistPractitioner - Dentist 4385933480

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Vaughn W Teuscher DDS, PS 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.

NPI Registry JSON

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104821289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2415 SE 165TH AVE",
            "address_2": "STE 102",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986834324",
            "telephone_number": "360-256-1202",
            "fax_number": "360-885-3580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 SE 165TH AVE",
            "address_2": "STE 102",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986834324",
            "telephone_number": "360-256-1202",
            "fax_number": "360-885-3580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEUSCHER",
        "first_name": "VAUGHN",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00006502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5017140",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON DENTAL SERVICE",
            "identifier": "56502",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT. OF L&I",
            "identifier": "146076",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.