Active NPI
James Russell Detwiler, D.D.S.
- General Practice Dentistry
- Perrysburg, OH
National Provider Identifier
1487761987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 13867
- Practice address
- 880 Commerce Dr
Suite a
Perrysburg, OH 43551-5240 - Phone
- (419) 874-3129
- Fax
- (419) 874-5007
- NPI assigned
- Aug 23, 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 | 13867 | OH | Primary |
Addresses
Primary practice location
880 Commerce Dr
Suite a
Perrysburg, OH 43551-5240
Mailing address
880 Commerce Dr
Suite a
Perrysburg, OH 43551-5240
Phone (419) 874-3129
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0217134 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13867 | OH | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DRS. Detwiler & Gannon, Inc. | General Practice | Past | Accepting new patients |
| Fort Meigs Dental Dr. Lauren Kollar LLC | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- General Practice Dentistry
- Perrysburg, OH
- NPI 1629185046
-
- Dental Clinic/Center
- Perrysburg, OH
- NPI 1588136113
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487761987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "880 COMMERCE DR",
"address_2": "SUITE A",
"city": "PERRYSBURG",
"state": "OH",
"postal_code": "435515240",
"telephone_number": "419-874-3129",
"fax_number": "419-874-5007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "880 COMMERCE DR",
"address_2": "SUITE A",
"city": "PERRYSBURG",
"state": "OH",
"postal_code": "435515240",
"telephone_number": "419-874-3129",
"fax_number": "419-874-5007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETWILER",
"first_name": "JAMES",
"middle_name": "RUSSELL",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OH",
"license": "13867",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0217134",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Perrysburg, OH
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.