Individual provider Active NPI

Nicholas Ray Button, D.M.D.

  • General Practice Dentistry
  • Albuquerque, NM
National Provider Identifier
1639424245
Registry record updated Sep 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN25465 Issued in FL
Practice address
6810 Menaul Blvd NE
Suite B
Albuquerque, NM 87110-3725
Phone
(505) 872-4422
NPI assigned
Jul 19, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DD2719 NM
General Practice Dentistry 1223G0001X DN25465 FL Primary

Addresses

Primary practice location

6810 Menaul Blvd NE
Suite B
Albuquerque, NM 87110-3725

Mailing address

10427 Sheldon Rd
Tampa, FL 33626-5110
Phone (813) 302-7126

Other practice location 1

10427 Sheldon Rd
Tampa, FL 33626
Phone (813) 302-7126

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
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
I20150803000751 NM Order and Referring Only - DentistPractitioner - Dentist 3173837226

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DD2719NMMDDentist
DN25465FLMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Dentists at Westchase, PA Dentist PastSince Sep 27, 2020 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.

NPI Registry JSON

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

{
    "created_epoch": "1342656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600905600000",
    "number": "1639424245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10427 SHELDON RD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336265110",
            "telephone_number": "813-302-7126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6810 MENAUL BLVD NE",
            "address_2": "SUITE B",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871103725",
            "telephone_number": "505-872-4422"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10427 Sheldon Rd",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "33626",
            "country_code": "US",
            "telephone_number": "813-302-7126",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUTTON",
        "first_name": "NICHOLAS",
        "middle_name": "RAY",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-19",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD2719",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN25465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.