Active NPI
Edward B Bodin, DMD
- General Practice Dentistry
- Tucson, AZ
National Provider Identifier
1508900705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D04062
- Practice address
- 3821 W Costco Dr
Suite 103
Tucson, AZ 85741-2890 - Phone
- (520) 575-8144
- Fax
- (520) 575-8144
- NPI assigned
- Feb 19, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4062 | AZ | |
| General Practice Dentistry | 1223G0001X | D04062 | AZ | Primary |
Addresses
Primary practice location
3821 W Costco Dr
Suite 103
Tucson, AZ 85741-2890
Mailing address
3821 W Costco Dr
Suite 103
Tucson, AZ 85741-2890
Phone (520) 575-8144
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 |
|---|---|---|---|
| 4062 | AZ | MD | Dentist |
| D04062 | AZ | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hossain Nasry DDS PC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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
- Tucson, AZ
- NPI 1619041241
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1497830400000",
"number": "1508900705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3821 W COSTCO DR",
"address_2": "SUITE 103",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857412890",
"telephone_number": "520-575-8144",
"fax_number": "520-575-8144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3821 W COSTCO DR",
"address_2": "SUITE 103",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857412890",
"telephone_number": "520-575-8144",
"fax_number": "520-575-8144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BODIN",
"first_name": "EDWARD",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-19",
"last_updated": "2017-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "4062",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AZ",
"license": "D04062",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.