Individual provider Active NPI

John Lee Bouzis, D.D.S

  • General Practice Dentistry
  • Casper, WY
National Provider Identifier
1417923681
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
641 Issued in WY
Practice address
130 N Ash St
Suite 202
Casper, WY 82601-1821
Phone
(307) 265-3595
Fax
(307) 265-0778
NPI assigned
Feb 27, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 641 WY Primary

Addresses

Primary practice location

130 N Ash St
Suite 202
Casper, WY 82601-1821

Mailing address

130 N Ash St
Suite 202
Casper, WY 82601-1821
Phone (307) 265-3595

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
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

Enrollment IDStateProvider typePAC IDDetails
I20150707003232 WY Order and Referring Only - DentistPractitioner - Dentist 9335451186

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Restful Sleep Plus LLC CurrentSince Sep 15, 2014 Accepting new patients
John L Bouzis Past Accepting new patients

Locations

130 N Ash St
Ste 202
Casper, WY 82601
Phone (307) 265-3595

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

NPI Registry JSON

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417923681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 N ASH ST",
            "address_2": "SUITE 202",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826011821",
            "telephone_number": "307-265-3595",
            "fax_number": "307-265-0778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 N ASH ST",
            "address_2": "SUITE 202",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826011821",
            "telephone_number": "307-265-3595",
            "fax_number": "307-265-0778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUZIS",
        "first_name": "JOHN",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WY",
            "license": "641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Casper, WY

Sources for this page

Verify at the official NPI Registry.