Henry Joseph Tagle III, D.M.D.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

6531 Issued in AZ

Practice address

1600 W. Univesity Ave Ste 103
Suite 102
Flagstaff, AZ 86001

Phone

(928) 774-4400

Fax

(928) 774-5436

NPI assigned

Feb 7, 2007

Last updated

Jan 25, 2017By 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 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 28, 2015 through Dec 28, 2027

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485302400000",
    "number": "1720128812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W. UNIVESITY AVE STE 103",
            "address_2": "SUITE 102",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "86001",
            "telephone_number": "928-774-4400",
            "fax_number": "928-774-5436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W. UNIVESITY AVE STE 103",
            "address_2": "SUITE 102",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "86001",
            "telephone_number": "928-774-4400",
            "fax_number": "928-774-5436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAGLE",
        "first_name": "HENRY",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-07",
        "last_updated": "2017-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "AZ",
            "license": "6531",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "6531",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "860875508",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michele Marie Switzer, M.D.
• Sumner Jay Sydeman, PH.D.
• Nicole Renee Sydow, M.D.
• Synaptic Psychiatry LLC (Revitalize and Optimize Clinic)
• Jessica Rose Szczepanski, PHD, RDN
• Renee Takehara
• Tiana Tallant, PT, DPT
• Alexander Kerway Tan, L.AC.
• Anna Rose Tang
• Jody M. Tanner, M.A.

• Endodontics in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Endodontics in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2017; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.