Individual provider Active NPI

Cheryl Lang Ullman, DMD

  • Endodontics
  • Rutland, VT
National Provider Identifier
1508875675
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
Practice address
71 Allen St
Suite 204
Rutland, VT 05701-4570
Phone
(802) 773-7767
Fax
(802) 775-7667
NPI assigned
Aug 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X VT Primary

Addresses

Primary practice location

71 Allen St
Suite 204
Rutland, VT 05701-4570

Mailing address

PO Box 130
Rutland, VT 05702-0130
Phone (802) 773-7767

Other identifiers 3

IdentifierTypeStateIssuer
9346OtherVTBC/BS
1009354MedicaidVT
1124OtherVTDELTA DENTAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
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
I20150318001583 VT Order and Referring Only - DentistPractitioner - Dentist 3870810542

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16-0001124VTMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Vermont Endontics, PC Endodontics Past Accepting new patients
Sovtendo, LLC PastSince Jan 10, 2021 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.

NPI Registry JSON

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

{
    "created_epoch": "1154822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508875675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057020130",
            "telephone_number": "802-773-7767",
            "fax_number": "802-775-7667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 ALLEN ST",
            "address_2": "SUITE 204",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014570",
            "telephone_number": "802-773-7767",
            "fax_number": "802-775-7667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ULLMAN",
        "first_name": "CHERYL",
        "middle_name": "LANG",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "VT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "9346",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1009354",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "1124",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rutland, VT

Sources for this page

Verify at the official NPI Registry.