Individual provider Active NPI

Joel W Teagarden, DDS

  • General Practice Dentistry
  • Bettendorf, IA
National Provider Identifier
1104862408
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6110 Issued in IA
Practice address
3520 Utica Ridge Rd
Bettendorf, IA 52722
Phone
(563) 359-9165
Fax
(563) 359-1824
NPI assigned
Jun 22, 2006
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 6110 IA Primary

Addresses

Primary practice location

3520 Utica Ridge Rd
Bettendorf, IA 52722

Mailing address

3520 Utica Ridge Rd
Bettendorf, IA 52722
Phone (563) 359-9165

Other identifiers 2

IdentifierTypeStateIssuer
1131235MedicaidIA
6110OtherIAIOWA DENTAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20160519001925 IA Order and Referring Only - DentistPractitioner - Dentist 6800185513

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Dentistry Unlimited 1 PLC General Practice Past Accepting new patients
Kimball & Beecher Group LLC General Practice PastSince Jan 15, 2023 Accepting new patients

Organizations & group practices 2

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": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104862408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3520 UTICA RIDGE RD",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "52722",
            "telephone_number": "563-359-9165",
            "fax_number": "563-359-1824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3520 UTICA RIDGE RD",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "52722",
            "telephone_number": "563-359-9165",
            "fax_number": "563-359-1824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEAGARDEN",
        "first_name": "JOEL",
        "middle_name": "W",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "6110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1131235",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA DENTAL",
            "identifier": "6110",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bettendorf, IA

Sources for this page

Verify at the official NPI Registry.