Main Street Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MAIN STREET DENTAL LLC

Practice address

330 Main St
Canon City, CO 81212-3732

Phone

(719) 275-3255

Fax

(719) 275-3863

NPI assigned

Nov 25, 2015

Last updated

Feb 9, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jacob Beus, DMDNPI 1811370588

Title

Owner

Phone

(719) 275-3255

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jacob Beus, DMD

  • General Practice Dentistry
  • Canon City, CO
  • NPI 1811370588
  NPD Authorized official

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

{
    "created_epoch": "1448409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675900800000",
    "number": "1669846838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 MAIN ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812123732",
            "telephone_number": "719-275-3255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 MAIN ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812123732",
            "telephone_number": "719-275-3255",
            "fax_number": "719-275-3863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-25",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A",
        "authorized_official_last_name": "BEUS",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-275-3255",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hillary Rae Lozano, DPT
• Sarah N Lukosi
• Crystal Lundy
• Kelsey Lungu
• M & D Dental LLC (Royal Family Dental)
• Heather Leigh Manning
• Marc a. Sindler, MD
• Shanele Renee Marquez, LPCC MS, INTERN
• Martic Anesthesia, LLC
• Marilyn Kay Martin, MSW

• General Practice Dentistry in Canon City, CO
• Providers in Canon City, 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 Feb 9, 2023; 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.