Gregory Charles Tellatin, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14175 Issued in MO

Practice address

1628 S. Campbell
Springfield, MO 65807-2002

Phone

(417) 862-0782

Fax

(417) 862-3866

NPI assigned

Oct 5, 2006

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 MO

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

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424649600000",
    "number": "1124114103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1628 S. CAMPBELL",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "65807",
            "telephone_number": "417-862-0782",
            "fax_number": "417-862-3866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1628 S. CAMPBELL",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658072002",
            "telephone_number": "417-862-0782",
            "fax_number": "417-862-3866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TELLATIN",
        "first_name": "GREGORY",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2015-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "14175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Arielle Tebbe, PHARMD
• Curt A Tebbe, RPH
• Wilconina Tecson, PT
• Morgan Belle Tegart, PHARMD
• Telerad of Mo Account Management, LLC
• Diderika M Telting, PH.D., CCC-SLP
• Teresa C Tempelmeyer, PHD
• Johnna Tenberge, PA-C
• Rebecca Tennison, LCSW
• Samantha Tennyson

• General Practice Dentistry in Springfield, MO
• Providers in Springfield, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2015; 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.