Justin Jack Nylund, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DD3407 Issued in NM

Practice address

1392 Weimer Rd Ste a
Taos, NM 87571-5308

Phone

(575) 758-8654

Fax

(575) 737-0970

NPI assigned

Feb 4, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

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

State licenses

Practice roles

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.

• Taos Dental Group

  • General Practice Dentistry
  • Taos, NM
  • NPI 1609267632
  NPD (past) Authorized official
• Taos Health Systems, Inc., Holy Cross Hospital

  • Critical Access Hospital
  • Taos, NM
  • NPI 1902338049
  NPD (past)

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

{
    "created_epoch": "1265241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449964800000",
    "number": "1306178132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1392 WEIMER RD. SUITE A",
            "city": "TAOS",
            "state": "NM",
            "postal_code": "87571",
            "telephone_number": "575-758-8654",
            "fax_number": "575-737-0970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1392 WEIMER RD STE A",
            "city": "TAOS",
            "state": "NM",
            "postal_code": "875715308",
            "telephone_number": "575-758-8654",
            "fax_number": "575-737-0970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NYLUND",
        "first_name": "JUSTIN",
        "middle_name": "JACK",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-02-04",
        "last_updated": "2015-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "10112",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD3407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Northern New Mexico Birth Center
• Northern New Mexico Birth Center
• Northern NM Center for Cosmetic Dentistry Inc
• NRS Arizona, PA
• Nyam Leng LLC
• Gina Kay O'Hara, PHARMD, PHC, RPH
• Aiden Matthew O'Rourke, M.D.
• Casey Odell, LPCC
• Amber Ohlinger, COMS
• Emma Okamoto, LCSW

• General Practice Dentistry in Taos, NM
• Providers in Taos, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2015; 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.