Active NPI
Jeremy R Dockstader, D.M.D.
- Dentist
- Albuquerque, NM
National Provider Identifier
1174772016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DD3444
- Practice address
- 4701 Lomas Blvd NE
Albuquerque, NM 87110-6233 - Phone
- (505) 232-2273
- NPI assigned
- Sep 16, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DD3444 | NM | Primary |
| General Practice Dentistry | 1223G0001X | 7106444-9922 | UT |
Addresses
Primary practice location
4701 Lomas Blvd NE
Albuquerque, NM 87110-6233
Mailing address
4701 Lomas Blvd
Albuquerque, NM 87110
Phone (505) 232-2273
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 273267056 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD3444 | NM | MD | Dentist |
| 7106444-9922 | UT | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359331200000",
"number": "1174772016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4701 LOMAS BLVD",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "87110",
"telephone_number": "505-232-2273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4701 LOMAS BLVD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871106233",
"telephone_number": "505-232-2273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOCKSTADER",
"first_name": "JEREMY",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-09-16",
"last_updated": "2013-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NM",
"license": "DD3444",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "UT",
"license": "7106444-9922",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "273267056",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.