Gregory Dale Cebulla, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00010391 Issued in WA

Practice address

2373 Old Tokeland Rd
Tokeland, WA 98590

Phone

(360) 267-8103

Fax

(360) 267-1437

NPI assigned

May 4, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

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

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: gcebulla297001@direct.ochin.org

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1679785463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 500",
            "city": "TOKELAND",
            "state": "WA",
            "postal_code": "985900500",
            "telephone_number": "360-267-8103",
            "fax_number": "360-267-1437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2373 OLD TOKELAND RD",
            "city": "TOKELAND",
            "state": "WA",
            "postal_code": "98590",
            "telephone_number": "360-267-8103",
            "fax_number": "360-267-1437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CEBULLA",
        "first_name": "GREGORY",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-04",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00010391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5051263",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pawel Michal Dutkiewicz, M.D.
• Joseph Goodfellow, LMHC-A
• Laura A Hamilton, CHEMICAL DEPENDENCY
• Pamela J Korzeniowski, PAC
• Jeanne Paul, LMFT

• General Practice Dentistry in Tokeland, WA
• Providers in Tokeland, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.