Michael Edward Daetwyler, D.D.S

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DEN.00204321 Issued in CO

Practice address

2014 Caribou Dr Ste 100
Fort Collins, CO 80525-4330

Phone

(970) 225-9555

Fax

(970) 223-2294

NPI assigned

May 4, 2016

Last updated

Dec 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Opted out of Medicare

Previously, effective Sep 1, 2022 through Sep 1, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fort Collins Oral & Maxillofacial Surgery Partnership

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Fort Collins, CO
  • NPI 1215659206
  NPD

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

{
    "created_epoch": "1462320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1225484629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2014 CARIBOU DR STE 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805254330",
            "telephone_number": "970-225-9555",
            "fax_number": "970-223-2294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2014 CARIBOU DR STE 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805254330",
            "telephone_number": "970-225-9555",
            "fax_number": "970-223-2294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAETWYLER",
        "first_name": "MICHAEL",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-04",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CO",
            "license": "DEN.00204321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jillian Czubek
• D Ampezzo Neurologica
• Michael Ann D'Ambrosia
• Maureen H D'Angelo, O.T.
• Jordan Da Silva, RD
• Burgundy Lu Dafoe
• Dani Marie Dague, MD
• Brian Dahlke
• Sarah Dailey
• Michael John Daine, PH.D.

• Oral and Maxillofacial Surgery (Dentist) in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Oral and Maxillofacial Surgery (Dentist) in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.