Andrew Wilson Dethloff, DDS. MA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

00204282 Issued in CO

Practice address

1777 Lake Woodmoor Dr
Monument, CO 80132-9074

Phone

(719) 488-3014

Fax

(719) 488-3015

NPI assigned

Feb 13, 2020

Last updated

Jan 26, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

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.

• Woodmoor Family Dentistry

  • Dental Clinic/Center
  • Monument, CO
  • NPI 1346833571
  NPD Authorized official

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

{
    "created_epoch": "1581552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1548893928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1777 LAKE WOODMOOR DR",
            "city": "MONUMENT",
            "state": "CO",
            "postal_code": "801329074",
            "telephone_number": "719-488-3014",
            "fax_number": "719-488-3015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1777 LAKE WOODMOOR DR",
            "city": "MONUMENT",
            "state": "CO",
            "postal_code": "801329074",
            "telephone_number": "719-488-3014",
            "fax_number": "719-488-3015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETHLOFF",
        "first_name": "ANDREW",
        "middle_name": "WILSON",
        "name_prefix": "Dr.",
        "credential": "DDS. MA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-02-13",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "00204282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Woodmoordental@gmail.com",
            "affiliation": "N",
            "address_1": "1777 Lake Woodmoor Dr",
            "city": "Monument",
            "state": "CO",
            "country_code": "US",
            "postal_code": "801329074",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Doctors Choice Surgical Assisting

• General Practice Dentistry in Monument, CO
• Providers in Monument, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2021; 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.