John Alton Vestal III, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

7935 Issued in CO

Practice address

302 W Montezuma Ave
Cortez, CO 81321-2750

Phone

(970) 565-3612

Fax

(970) 565-6069

NPI assigned

Aug 23, 2005

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• 4 Corners Dental Sleep Solutions LLC

  • Durable Medical Equipment & Medical Supplies
  • Cortez, CO
  • NPI 1902460017
  NPD Authorized official
• Tavamuwisi Dental Group PLLC

  • Dental Clinic/Center
  • Cortez, CO
  • NPI 1689426413
  NPD

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676851200000",
    "number": "1417940727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 W MONTEZUMA AVE",
            "city": "CORTEZ",
            "state": "CO",
            "postal_code": "813212750",
            "telephone_number": "970-565-3612",
            "fax_number": "970-565-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 W MONTEZUMA AVE",
            "city": "CORTEZ",
            "state": "CO",
            "postal_code": "813212750",
            "telephone_number": "970-565-3612",
            "fax_number": "970-565-6069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VESTAL",
        "first_name": "JOHN",
        "middle_name": "ALTON",
        "name_suffix": "III",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-23",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CO",
            "license": "7935",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "7935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert D Underwood, OD
• Robert Tyler Underwood, O.D.
• Daniel Glenn Valverde, PHARMACIST
• Jerry Vandiver, R.PH.
• Anthony F Verow, MD
• Eric Andrew Viquez, MD
• Megan Perez Viquez, M.D.
• Vista Grande Inn, Inc
• Vista Grande Inn, Inc.
• Vista Grande Rehabilitation and Healthcare Center LLC

• Dentist in Cortez, CO
• Providers in Cortez, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2023; 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.