Richard C. Tatum Jr., D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D6672 Issued in AZ

Practice address

167 N. Main St
Tuba City, AZ 86045

Phone

(928) 283-2672

Fax

(928) 283-2991

NPI assigned

Aug 30, 2006

Last updated

Jun 8, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Practice roles

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.

• Tuba City Regional Health Care Corporation

  dba Tuba City Indian Medical Center

  • General Acute Care Hospital
  • Tuba City, AZ
  • NPI 1548294424

  TX

  Medicare reassignment
• Tuba City Regional Health Care Corporation

  dba Cameron Dental Clinic

  • Family Medicine Physician
  • Cameron, AZ
  • NPI 1134382211

  General Practice

  NPD

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307491200000",
    "number": "1710096706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3008 E. BIRCH AVE",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "860450600",
            "telephone_number": "928-283-2672",
            "fax_number": "928-283-2991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 N. MAIN ST",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "86045",
            "telephone_number": "928-283-2672",
            "fax_number": "928-283-2991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATUM",
        "first_name": "RICHARD",
        "middle_name": "C.",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2011-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "12754",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D6672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "888927",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Tallsalt
• Ma Fatima Balforlyn Tan
• Ha Cam Tang, DO
• Lewin Taquiso, RN
• Jadoon Tasneem
• Allis Vanessa Tavarez, RN
• Jimmie L Taylor, RN
• Thomas L Taylor, DDS
• Tcrhcc Mobile Healthcare Van System (Community Health Mobile Medical)
• Tcrhcc Mobile Healthcare Van System (2)

• General Practice Dentistry in Tuba City, AZ
• Providers in Tuba City, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; 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.