Active NPI
Bo Tran, DDS
- Dentist
- Gallup, NM
National Provider Identifier
1154603959
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DD3518
- Practice address
- 516 East Nizhoni Blvd
Gallup, NM 87301 - Phone
- (505) 722-1000
- NPI assigned
- Sep 16, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DD3518 | NM | Primary |
Addresses
Primary practice location
516 East Nizhoni Blvd
Gallup, NM 87301
Mailing address
P.O. Box 1337
Gallup, NM 87305-1337
Phone (505) 722-1560
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190102001297 | NM | Order and Referring Only - Dentist | 3870742570 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316131200000",
"number": "1154603959",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 1337",
"city": "GALLUP",
"state": "NM",
"postal_code": "873051337",
"telephone_number": "505-722-1560",
"fax_number": "505-722-1565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "516 EAST NIZHONI BLVD",
"city": "GALLUP",
"state": "NM",
"postal_code": "87301",
"telephone_number": "505-722-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRAN",
"first_name": "BO",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-16",
"last_updated": "2011-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NM",
"license": "DD3518",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gallup, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2011; 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.