Jacob Beus, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DEN.00202758 Issued in CO

Practice address

330 Main St
Canon City, CO 81212-3732

Phone

(719) 275-3255

Fax

(719) 275-3863

NPI assigned

Jun 30, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Main Street Dental LLC

  • General Practice Dentistry
  • Canon City, CO
  • NPI 1669846838

  General Practice

  NPD Authorized official

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

{
    "created_epoch": "1435622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672790400000",
    "number": "1811370588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 MAIN ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812123732",
            "telephone_number": "719-275-3255",
            "fax_number": "719-275-3863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 MAIN ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812123732",
            "telephone_number": "719-275-3255",
            "fax_number": "719-275-3863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEUS",
        "first_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-30",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "6184711-9922",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "DEN.00202758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robin Bangasser Bentley, FNP-C
• Amy Bergant, MSW
• Patricia L Berndt, NP
• Demmi Berry
• Melanie Betts
• Tina Lorraine Bezona, LPC
• Kellie Bird
• Robert Marvin Bischoff, PTA
• Ginger L Bivens, RN
• Blair Vision Care, LLC

• All providers in Canon City, CO
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.