Individual provider Active NPI

Mason Miner, DDS

  • General Practice Dentistry
  • Durango, CO
National Provider Identifier
1487049219
Registry record updated Oct 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8689 Issued in CO
Practice address
72 Suttle St Unit H
Durango, CO 81303-6829
Phone
(970) 247-2677
Fax
(970) 382-9581
NPI assigned
Mar 30, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 2, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 8689 CO Primary
Durable Medical Equipment & Medical Supplies 332B00000X 8689 CO

Addresses

Primary practice location

72 Suttle St Unit H
Durango, CO 81303-6829

Mailing address

72 Suttle St Unit H
Durango, CO 81303-6829
Phone (970) 247-2677

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20150624000063 CO Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 7012228604

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8689COMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Mason O Miner DDS LLC Durable Medical Equipment & Medical Supplies CurrentSince Mar 4, 2004 Accepting new patients

Locations

72 Suttle St
Unit H
Durango, CO 81303
Phone (970) 247-2677

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.

NPI Registry JSON

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

{
    "created_epoch": "1427673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569974400000",
    "number": "1487049219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 SUTTLE ST UNIT H",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813036829",
            "telephone_number": "970-247-2677",
            "fax_number": "970-382-9581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 SUTTLE ST UNIT H",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813036829",
            "telephone_number": "970-247-2677",
            "fax_number": "970-382-9581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINER",
        "first_name": "MASON",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-03-30",
        "last_updated": "2019-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "8689",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CO",
            "license": "8689",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durango, CO

Sources for this page

Verify at the official NPI Registry.