Active NPI
Russell T Thaler, DMD,MS
- Periodontics
- Maumee, OH
National Provider Identifier
1215145693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 30-023000
- Practice address
- 5757 Monclova Rd
Suite 12
Maumee, OH 43537-1863 - Phone
- (419) 893-0253
- NPI assigned
- May 18, 2007
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 30-023000 | OH | Primary |
Addresses
Primary practice location
5757 Monclova Rd
Suite 12
Maumee, OH 43537-1863
Mailing address
9024 Cedar Bend Rd
Sylvania, OH 43560-9394
Phone (419) 340-8455
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- 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 |
|---|---|---|---|---|
| I20160216002301 | OH | Order and Referring Only - Dentist | 9739484577 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30-023000 | OH | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322611200000",
"number": "1215145693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9024 CEDAR BEND RD",
"city": "SYLVANIA",
"state": "OH",
"postal_code": "435609394",
"telephone_number": "419-340-8455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5757 MONCLOVA RD",
"address_2": "SUITE 12",
"city": "MAUMEE",
"state": "OH",
"postal_code": "435371863",
"telephone_number": "419-893-0253"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THALER",
"first_name": "RUSSELL",
"middle_name": "T",
"credential": "DMD,MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-18",
"last_updated": "2011-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "OH",
"license": "30-023000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maumee, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.