Individual provider Active NPI

Nathalie Louise Tungesvik, DDS

  • General Practice Dentistry
  • Jefferson City, MO
National Provider Identifier
1659486298
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
015327 Issued in MO
Practice address
994 Diamond RDG
Suite 200
Jefferson City, MO 65109-6885
Phone
(573) 635-3576
Fax
(573) 634-2597
NPI assigned
Aug 21, 2006
Sex
Female
Sole proprietor
No

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 015327 MO Primary

Addresses

Primary practice location

994 Diamond RDG
Suite 200
Jefferson City, MO 65109-6885

Mailing address

3555 Antietam CT
Jefferson City, MO 65109-6899
Phone (573) 893-8380

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20151104000458 MO Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 5092025031

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Nathalie Tungesvik,DDS,PC General Practice Past Accepting new patients
Diamond Ridge Dentistry LLC General Practice PastSince Apr 9, 2024 Accepting new patients

Organizations & group practices 2

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": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659486298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3555 ANTIETAM CT",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651096899",
            "telephone_number": "573-893-8380",
            "fax_number": "573-634-2597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "994 DIAMOND RDG",
            "address_2": "SUITE 200",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651096885",
            "telephone_number": "573-635-3576",
            "fax_number": "573-634-2597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUNGESVIK",
        "first_name": "NATHALIE",
        "middle_name": "LOUISE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "015327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson City, MO

Sources for this page

Verify at the official NPI Registry.