Individual provider Active NPI

Tyler David Burningham, DMD

  • Dentist
  • Radford, VA
National Provider Identifier
1760644181
Registry record updated Jun 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401412200 Issued in VA
Practice address
1151 E Main St
Suite a
Radford, VA 24141-1761
Phone
(540) 639-1674
Fax
(540) 639-9205
NPI assigned
Jun 26, 2008
Last updated
Jun 26, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 0401412200 VA Primary

Addresses

Primary practice location

1151 E Main St
Suite a
Radford, VA 24141-1761

Mailing address

1151 E Main St
Suite a
Radford, VA 24141-1761
Phone (540) 639-1674

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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

Enrollment IDStateProvider typePAC IDDetails
I20150729007843 VA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 1759695125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0401412200VAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Radford Family Dental, Inc. Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1214438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214438400000",
    "number": "1760644181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1151 E MAIN ST",
            "address_2": "SUITE A",
            "city": "RADFORD",
            "state": "VA",
            "postal_code": "241411761",
            "telephone_number": "540-639-1674",
            "fax_number": "540-639-9205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 E MAIN ST",
            "address_2": "SUITE A",
            "city": "RADFORD",
            "state": "VA",
            "postal_code": "241411761",
            "telephone_number": "540-639-1674",
            "fax_number": "540-639-9205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNINGHAM",
        "first_name": "TYLER",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-26",
        "last_updated": "2008-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401412200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Radford, VA

Sources for this page

Verify at the official NPI Registry.