Active NPI
Delton Todd Tatum, DDS
- Dentist
- Amarillo, TX
National Provider Identifier
1194335539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 36455
- Practice address
- 2815 S Georgia St
Amarillo, TX 79109-1975 - Phone
- (806) 358-7646
- NPI assigned
- Jul 31, 2020
- Last updated
- Jul 31, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 36455 | TX | Primary |
Addresses
Primary practice location
2815 S Georgia St
Amarillo, TX 79109-1975
Mailing address
2815 S Georgia St
Amarillo, TX 79109-1975
Phone (806) 358-7646
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 |
|---|---|---|---|
| 36455 | TX | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596153600000",
"number": "1194335539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2815 S GEORGIA ST",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791091975",
"telephone_number": "806-358-7646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2815 S GEORGIA ST",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791091975",
"telephone_number": "806-358-7646"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TATUM",
"first_name": "DELTON",
"middle_name": "TODD",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-07-31",
"last_updated": "2020-07-31",
"certification_date": "2020-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "36455",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Amarillo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.