Reimy Evangelista de Leon, DDS

Primary specialty

Orofacial Pain DentistryTaxonomy code 1223X2210X

License

016.0134038 Issued in VT

Practice address

40A Timber LN
South Burlington, VT 05403-7204

Phone

(802) 862-7185

NPI assigned

Jul 12, 2018

Reactivated

Mar 25, 2019

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

Medicare fee-for-service enrollment

Enrolled in VT

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

Specialty

Dentist

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Vermont Dental Medicine PLLC

  • Dentist
  • South Burlington, VT
  • NPI 1932245362
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1531353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1750867800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40A TIMBER LN",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037204",
            "telephone_number": "802-862-7185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40A TIMBER LN",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037204",
            "telephone_number": "802-862-7185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANGELISTA DE LEON",
        "first_name": "REIMY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-12",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "deactivation_date": "2019-02-13",
        "reactivation_date": "2019-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X2210X",
            "taxonomy_group": "",
            "desc": "Dentist, Orofacial Pain",
            "state": "VT",
            "license": "016.0134038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Georgia D Eltabbakh, P.A.
• Elvira Zulkic, MSW. LLC
• Jill Lorraine Entis, LICSW
• Erik Willis, Ma, LLC
• Lisa Martin Eriksson, O.D.
• Eye Vermont LLC
• Lindsay Fagan, MSW
• Markus Fankhauser, LCMHC
• Liam Henry Farrell, MA
• William Henry Farrell III, PHD

• Orofacial Pain Dentistry in South Burlington, VT
• Providers in South Burlington, VT by specialty
• Orofacial Pain Dentistry in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.