Active NPI
Landon Momberg, DDM
- Dentist
- Nome, AK
National Provider Identifier
1821576430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DEN.00203726
- Practice address
- 1000 Greg Kruschek Ave
Nome, AK 99762-0966 - Phone
- (907) 443-3311
- NPI assigned
- Aug 6, 2018
- Last updated
- Aug 19, 2020
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | DEN.00203726 | CO | Primary |
Addresses
Primary practice location
1000 Greg Kruschek Ave
Nome, AK 99762-0966
Mailing address
PO Box 966
Nome, AK 99762-0966
Phone (907) 443-3309
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 |
|---|---|---|---|
| DEN.00203726 | CO | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597795200000",
"number": "1821576430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 966",
"city": "NOME",
"state": "AK",
"postal_code": "997620966",
"telephone_number": "907-443-3309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 GREG KRUSCHEK AVE",
"city": "NOME",
"state": "AK",
"postal_code": "997620966",
"telephone_number": "907-443-3311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOMBERG",
"first_name": "LANDON",
"credential": "DDM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-06",
"last_updated": "2020-08-19",
"certification_date": "2020-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "DEN.00203726",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nome, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.