Mary B Medige

Primary specialty

Dental AssistantTaxonomy code 126800000X

Practice address

21 Dental Squadron/SGDD
1055 E. Stewart BLDG 2018
Peterson Afb, CO 80925

Phone

(719) 566-1333

NPI assigned

Sep 25, 2020

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1600992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600992000000",
    "number": "1598372476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 DENTAL SQUADRON/SGDD",
            "address_2": "1055 E. STEWART BLDG 2018",
            "city": "PETERSON AFB",
            "state": "CO",
            "postal_code": "80925",
            "telephone_number": "719-566-1333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 DENTAL SQUADRON/SGDD",
            "address_2": "1055 E. STEWART BLDG 2018",
            "city": "PETERSON AFB",
            "state": "CO",
            "postal_code": "80925",
            "telephone_number": "719-566-1333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDIGE",
        "first_name": "MARY",
        "middle_name": "B",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-25",
        "last_updated": "2020-09-25",
        "certification_date": "2020-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelly Lloyd, MSW, LCSW
• James Arthur Loe, DMD
• Winnie Lok, RPH
• Scott Lee Maynard, LMSW
• Matthew Sean McDonough, M.D.
• Joseph Edward Meno III, USAF IDMT-PARAMEDIC
• Michelle Montgomery, WHNP
• Andrew Erle Moore, M.D.
• Janel Sharp Moreno, ARNP
• Todd William Neu, PSYCHOLOGIST PHD

• Dental Assistant in Peterson Afb, CO
• Providers in Peterson Afb, CO by specialty
• Dental Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2020; 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.