Active NPI
Devin V. Nelson, DMD
- General Practice Dentistry
- Evanston, WY
National Provider Identifier
1346505070
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1317
- Practice address
- 545 Cheyenne Dr
Suite C
Evanston, WY 82930-5323 - Phone
- (307) 789-9034
- Fax
- (307) 789-9065
- NPI assigned
- Jul 9, 2012
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1317 | WY | Primary |
Addresses
Primary practice location
545 Cheyenne Dr
Suite C
Evanston, WY 82930-5323
Mailing address
545 Cheyenne Dr
Suite C
Evanston, WY 82930-5323
Phone (307) 789-9034
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 |
|---|---|---|---|
| 1317 | WY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blue Tooth Dental Inc. | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Evanston, WY
- NPI 1063664795
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1341792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341792000000",
"number": "1346505070",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "545 CHEYENNE DR",
"address_2": "SUITE C",
"city": "EVANSTON",
"state": "WY",
"postal_code": "829305323",
"telephone_number": "307-789-9034",
"fax_number": "307-789-9065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "545 CHEYENNE DR",
"address_2": "SUITE C",
"city": "EVANSTON",
"state": "WY",
"postal_code": "829305323",
"telephone_number": "307-789-9034",
"fax_number": "307-789-9065"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "DEVIN",
"middle_name": "V.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-07-09",
"last_updated": "2012-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WY",
"license": "1317",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evanston, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.