Tashana Detwiler, DMD

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

License

12420 Issued in NC

Practice address

280 Concord Pkwy S Ste 110a
Concord, NC 28027-2704

Phone

(704) 920-1070

Fax

(704) 920-1071

NPI assigned

Aug 4, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Charlotte Community Health Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Charlotte, NC
  • NPI 1528363868
  Medicare reassignment NPD
• Charlotte Community Health Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Charlotte, NC
  • NPI 1073367249
  NPD
• Charlotte Community Health Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Charlotte, NC
  • NPI 1215499520

  Dental Public Health

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628035200000",
    "number": "1205500147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5008 SHADOW PINE DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282695142",
            "telephone_number": "704-780-3714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 CONCORD PKWY S STE 110A",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280272704",
            "telephone_number": "704-920-1070",
            "fax_number": "704-920-1071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETWILER",
        "first_name": "TASHANA",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-04",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "NC",
            "license": "12420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dermatology Group of the Carolinas
• Mark S Dermer, MD
• Rhode Desauguste, PMHNP
• Cynthia Cheung Desilva, RPH
• Mary Jean Detchemendy, CRNA
• Mary Elizabeth Devlin
• Tiffany Moore Dewitt, CRNA
• Jeremy Dewolf, PA-C
• Diana'S Homecare, Inc
• Diana'S Homecare, Inc.

• Public Health Dentistry in Concord, NC
• Providers in Concord, NC by specialty
• Public Health Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; 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.

Verify at the official NPI Registry.