Kasey William Tea, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

DEN.00203017 Issued in CO

Practice address

Rheinland-Pfalz Dha
CMR 402 Unit 33301
Apo, AE 09180

Phone

(314) 590-7261

NPI assigned

Mar 4, 2015

Last updated

Mar 30, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Summit Family Dental of Bernalillo, LLC

  • Dental Clinic/Center
  • Rio Rancho, NM
  • NPI 1346833878
  NPD (past)
• Summit Family Dental of Farmington, LLC

  • General Practice Dentistry
  • Farmington, NM
  • NPI 1427320654
  NPD (past)

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

{
    "created_epoch": "1425427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680134400000",
    "number": "1114319845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 E 30TH ST",
            "address_2": "SUITE 3",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874019407",
            "telephone_number": "505-327-9161",
            "fax_number": "505-326-6657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "MIL",
            "address_1": "RHEINLAND-PFALZ DHA",
            "address_2": "CMR 402 UNIT 33301",
            "city": "APO",
            "state": "AE",
            "postal_code": "09180",
            "telephone_number": "314-590-7261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEA",
        "first_name": "KASEY",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-04",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "DEN.00203017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; 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.

Verify at the official NPI Registry.