Active NPI
Thomas Joseph Havlichek, DDS
- Dentist
- Fort Carson, CO
National Provider Identifier
1285361907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901601306
- Practice address
- 1667 Cochrane Cir BLDG 7495
Fort Carson, CO 80913-4603 - Phone
- (719) 526-5537
- NPI assigned
- Aug 3, 2022
- Sex
- Male
- Sole proprietor
- No
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 | 2901601306 | MI | Primary |
Addresses
Primary practice location
1667 Cochrane Cir BLDG 7495
Fort Carson, CO 80913-4603
Mailing address
13105 Hide Away LN
Dewitt, MI 48820-9184
Phone (517) 582-9599
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 |
|---|---|---|---|
| 2901601306 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1659484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694390400000",
"number": "1285361907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13105 HIDE AWAY LN",
"city": "DEWITT",
"state": "MI",
"postal_code": "488209184",
"telephone_number": "517-582-9599"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1667 COCHRANE CIR BLDG 7495",
"city": "FORT CARSON",
"state": "CO",
"postal_code": "809134603",
"telephone_number": "719-526-5537"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAVLICHEK",
"first_name": "THOMAS",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-08-03",
"last_updated": "2023-09-11",
"certification_date": "2023-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901601306",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Carson, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.