Carolyn D Bustillos

Primary specialty

Dental AssistantTaxonomy code 126800000X

License

38985 Issued in CA

Practice address

Building N-46 Cape Sarichef
Kodiak, AK 99619-5002

Phone

(907) 487-5757

Fax

(907) 487-5360

NPI assigned

Mar 24, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Carolyn D Long Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Integrated Support Command Kodiak

  • Clinic/Center
  • Kodiak, AK
  • NPI 1720064884
  NPD (past)

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

{
    "created_epoch": "1237852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237852800000",
    "number": "1508008467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BUILDING N-46 CAPE SARICHEF",
            "city": "KODIAK",
            "state": "AK",
            "postal_code": "996195002",
            "telephone_number": "907-487-5757",
            "fax_number": "907-487-5360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BUILDING N-46 CAPE SARICHEF",
            "city": "KODIAK",
            "state": "AK",
            "postal_code": "996195002",
            "telephone_number": "907-487-5757",
            "fax_number": "907-487-5360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSTILLOS",
        "first_name": "CAROLYN",
        "middle_name": "D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-24",
        "last_updated": "2009-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": "CA",
            "license": "38985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "LONG",
            "middle_name": "D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Katherine Buchinger, M. ED.
• Paige Buer, PA-C
• Suzanne Marie Buie, DPT
• Christopher Edwin Burnside
• Stephen Spencer Burnside, MD
• Amy Butts, RN, BSN
• Kristy A Campbell
• Carrie Randolph D.D.S. Inc.
• Scott Allen Carver, CRNA
• John Franklin Caudill, II, D.M.D.

• Dental Assistant in Kodiak, AK
• Providers in Kodiak, AK by specialty
• Dental Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.