Active NPI
Dan Joseph Dettmann, L.D.
- Denturist
- Corvallis, OR
National Provider Identifier
1801034335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Denturist
- License
- DT-DO-433361
- Practice address
- 33894 SE Eastgate Cir
Corvallis, OR 97333-2248 - Phone
- (541) 754-4901
- NPI assigned
- Jan 21, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Denturist | 122400000X | DT-DO-433361 | OR | Primary |
Addresses
Primary practice location
33894 SE Eastgate Cir
Corvallis, OR 97333-2248
Mailing address
261 Boden St
Junction City, OR 97448-1525
Phone (541) 913-5609
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT-DO-433361 | OR | MD | Denturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232496000000",
"number": "1801034335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "261 BODEN ST",
"city": "JUNCTION CITY",
"state": "OR",
"postal_code": "974481525",
"telephone_number": "541-913-5609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33894 SE EASTGATE CIR",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973332248",
"telephone_number": "541-754-4901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETTMANN",
"first_name": "DAN",
"middle_name": "JOSEPH",
"credential": "L.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-21",
"last_updated": "2009-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "122400000X",
"taxonomy_group": "",
"desc": "Denturist",
"state": "OR",
"license": "DT-DO-433361",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corvallis, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.