Individual provider Active NPI

Craig Scott Schluter, D.D.S.

  • General Practice Dentistry
  • Canon City, CO
National Provider Identifier
1659383487
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
104926 Issued in CO
Practice address
210 N 19TH St
Canon City, CO 81212-2423
Phone
(719) 275-2454
Fax
(719) 275-3098
NPI assigned
Aug 12, 2006
Sex
Male
Sole proprietor
Yes

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
General Practice Dentistry 1223G0001X 104926 CO Primary

Addresses

Primary practice location

210 N 19TH St
Canon City, CO 81212-2423

Mailing address

210 N 19TH St
Canon City, CO 81212-2423
Phone (719) 275-2454

Other identifiers 1

IdentifierTypeStateIssuer
02049260MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20200424001892 CO Practitioner - Dentist 7618269630 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
104926COMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Bradley J. Schluter, D.D.S. Inc. CurrentSince Apr 11, 2020 Accepting new patients

Locations

210 N 19th St
Canon City, CO 81212
Phone (719) 275-2454

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659383487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 N 19TH ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812122423",
            "telephone_number": "719-275-2454",
            "fax_number": "719-275-3098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 N 19TH ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812122423",
            "telephone_number": "719-275-2454",
            "fax_number": "719-275-3098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHLUTER",
        "first_name": "CRAIG",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "104926",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02049260",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canon City, CO

Sources for this page

Verify at the official NPI Registry.