Gary R Dettman, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

019-020199 Issued in IL

Practice address

110 E Washington St
Marengo, IL 60152-3107

Phone

(815) 568-1202

NPI assigned

Nov 3, 2006

Last updated

Sep 9, 2008By the provider in NPPES

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 IL

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Marengo Dental

  • General Practice Dentistry
  • Marengo, IL
  • NPI 1760608731
  NPD (past) Authorized official
• Liliana Paz DDS PLLC

  • General Practice Dentistry
  • Marengo, IL
  • NPI 1164187308
  NPD (past)

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220918400000",
    "number": "1851470470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E WASHINGTON ST",
            "city": "MARENGO",
            "state": "IL",
            "postal_code": "601523107",
            "telephone_number": "815-568-1202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E WASHINGTON ST",
            "city": "MARENGO",
            "state": "IL",
            "postal_code": "601523107",
            "telephone_number": "815-568-1202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETTMAN",
        "first_name": "GARY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2008-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019-020199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dana Christiansen
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• David Danielsen
• Anmarie Deller, OTR/L
• Dr Matts Office LTD
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• Rebecca Lynn Feuerborn, PHARM.D, R.PH.
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• Dentist in Marengo, IL
• Providers in Marengo, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.