Active NPI
James Milton Mobley, DMD
- General Practice Dentistry
- Pueblo, CO
National Provider Identifier
1285662817
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DEN-7119
- Practice address
- 2030 Lake Ave
Pueblo, CO 81004-3536 - Phone
- (719) 564-4823
- Fax
- (719) 564-4858
- NPI assigned
- Jun 30, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DEN-7119 | CO | Primary |
Addresses
Primary practice location
2030 Lake Ave
Pueblo, CO 81004-3536
Mailing address
110 E. Routt Avenue
Pueblo, CO 81004
Phone (719) 543-8711
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 44526369 | Medicaid | CO | |
| 0017550 | Other | DORAL | |
| 200372340A | Medicaid | KS |
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 |
|---|---|---|---|
| DEN-7119 | CO | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pueblo Community Health Center Inc. | Past | Accepting new patients | |
| Pueblo Community Health Center Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Federally Qualified Health Center (FQHC)
- Pueblo, CO
- NPI 1952071219
-
- Federally Qualified Health Center (FQHC)
- Pueblo, CO
- NPI 1245275932
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389916800000",
"number": "1285662817",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 E. ROUTT AVENUE",
"city": "PUEBLO",
"state": "CO",
"postal_code": "81004",
"telephone_number": "719-543-8711",
"fax_number": "719-585-3038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2030 LAKE AVE",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810043536",
"telephone_number": "719-564-4823",
"fax_number": "719-564-4858"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOBLEY",
"first_name": "JAMES",
"middle_name": "MILTON",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-30",
"last_updated": "2014-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CO",
"license": "DEN-7119",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "44526369",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DORAL",
"identifier": "0017550",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200372340A",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.