Paul Pantleo

Key facts

NPI

1124276159

Entity type

Individual (NPI type 1)

Primary specialty

Dentist 122300000X

License

D9802 (OR)

Practice address

1097 Baltimore Ave SE.
Bandon, OR 97411-8855

Phone

(541) 329-0550

Fax

(541) 329-0309

NPI assigned

Sep 3, 2008

Sex

Male

Sole proprietor

Yes

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.

• Bandon Coastal Dental, LLC Clinic/Center · Bandon, OR · NPI 1063756401
  NPD (past) Authorized official

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 3, 2012.

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354492800000",
    "number": "1124276159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1097 BALTIMORE AVE",
            "city": "BANDON",
            "state": "OR",
            "postal_code": "97411",
            "telephone_number": "541-329-0550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1097 BALTIMORE AVE SE.",
            "city": "BANDON",
            "state": "OR",
            "postal_code": "974118855",
            "telephone_number": "541-329-0550",
            "fax_number": "541-329-0309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANTLEO",
        "first_name": "PAUL",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-03",
        "last_updated": "2012-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D9802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Bandon, OR · Dentist in Oregon