John Brett Bettis, DMD

Key facts

NPI

1184648917

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

License

5069 (AL)

Practice address

750 US Highway 11
Suite 4
Trussville, AL 35173-4391

Phone

(205) 467-2211

Fax

(205) 467-9744

NPI assigned

Jul 26, 2006

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.

• J Brett Bettis DMD,PC Dentist · Trussville, AL · NPI 1437341203
  NPD (past) Authorized official

Medicare participation

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

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 Apr 8, 2008.

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207612800000",
    "number": "1184648917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 HIGHWAY 11",
            "address_2": "SUITE 4",
            "city": "TRUSSVILLE",
            "state": "AL",
            "postal_code": "351732877",
            "telephone_number": "205-467-2211",
            "fax_number": "205-467-9744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 US HIGHWAY 11",
            "address_2": "SUITE 4",
            "city": "TRUSSVILLE",
            "state": "AL",
            "postal_code": "351734391",
            "telephone_number": "205-467-2211",
            "fax_number": "205-467-9744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETTIS",
        "first_name": "JOHN",
        "middle_name": "BRETT",
        "name_prefix": "Mr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2008-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "5069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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