Active NPI
Harry Talbott Tebay, DDS
- General Practice Dentistry
- Vienna, WV
National Provider Identifier
1487675690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1953
- Practice address
- 1301 Grand Central Ave
Vienna, WV 26105-1052 - Phone
- (304) 295-8282
- Fax
- (304) 295-8282
- NPI assigned
- Jul 22, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1953 | WV | Primary |
Addresses
Primary practice location
1301 Grand Central Ave
Vienna, WV 26105-1052
Mailing address
1301 Grand Central Ave
Vienna, WV 26105-1052
Phone (304) 295-8282
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0136045000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Sep 1, 2013 through Sep 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487675690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1301 GRAND CENTRAL AVE",
"city": "VIENNA",
"state": "WV",
"postal_code": "261051052",
"telephone_number": "304-295-8282",
"fax_number": "304-295-8282"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 GRAND CENTRAL AVE",
"city": "VIENNA",
"state": "WV",
"postal_code": "261051052",
"telephone_number": "304-295-8282",
"fax_number": "304-295-8282"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEBAY",
"first_name": "HARRY",
"middle_name": "TALBOTT",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WV",
"license": "1953",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0136045000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vienna, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.