Active NPI
Nathan Vassiliades, D.D.S.
- Dentist
- Taylorsville, UT
National Provider Identifier
1467892992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8821
- Practice address
- 3484 W Ridgecrest Dr
Taylorsville, UT 84129-3332 - Phone
- (801) 450-7025
- NPI assigned
- Jun 28, 2013
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 8821 | AZ | Primary |
Addresses
Primary practice location
3484 W Ridgecrest Dr
Taylorsville, UT 84129-3332
Mailing address
18550 E Rittenhouse Rd Ste 103
Queen Creek, AZ 85142-4599
Phone (801) 450-7025
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150820011264 | CA | Order and Referring Only - Dentist | 7719292648 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8821 | AZ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384214400000",
"number": "1467892992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18550 E RITTENHOUSE RD STE 103",
"city": "QUEEN CREEK",
"state": "AZ",
"postal_code": "851424599",
"telephone_number": "801-450-7025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3484 W RIDGECREST DR",
"city": "TAYLORSVILLE",
"state": "UT",
"postal_code": "841293332",
"telephone_number": "801-450-7025"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VASSILIADES",
"first_name": "NATHAN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-06-28",
"last_updated": "2013-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "8821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Taylorsville, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2013; 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.