NPIMap

Individual provider Active NPI

Bryce Haslam

  • Dentist
  • Las Vegas, NV
National Provider Identifier
1508255878
Registry record updated Jan 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6531 Issued in NV
Practice address
4380 Blue Diamond Rd Ste 102
Las Vegas, NV 89139-7786
Phone
(702) 425-4424
Fax
(702) 875-4320
NPI assigned
Jan 9, 2015
Last updated
Jan 9, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 9, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 6531 NV Primary

Addresses

Primary practice location

4380 Blue Diamond Rd Ste 102
Las Vegas, NV 89139-7786

Mailing address

4380 Blue Diamond Rd Ste 102
Las Vegas, NV 89139-7786

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

LicenseStateTypeSpecialty
6531NVMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Dental Services Past Accepting new patients
Watanabe Diamond Dental Group, Professional Corporation Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://epicproxy.et1079.epichosted.com/FHIRProxy/api/FHIR/R4/

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1420761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420761600000",
    "number": "1508255878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4380 BLUE DIAMOND RD STE 102",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891397786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4380 BLUE DIAMOND RD STE 102",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891397786",
            "telephone_number": "702-425-4424",
            "fax_number": "702-875-4320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASLAM",
        "first_name": "BRYCE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-01-09",
        "last_updated": "2015-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NV",
            "license": "6531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2015; 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.