Alexis Carrie Pelton, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DE61558951 Issued in WA

Practice address

910 NE 82ND St
Vancouver, WA 98665-8847

Phone

(855) 433-6825

NPI assigned

Jun 10, 2024

Sex

Female

Sole proprietor

Yes

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 WA

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 and National Provider Directory roles.

• Willamette Dental Group, P.C.

  • Dentist
  • Vancouver, WA
  • NPI 1194640557
  NPD (past)

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

{
    "created_epoch": "1717977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1861234908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 NE 82ND ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986658847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 NE 82ND ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986658847",
            "telephone_number": "855-433-6825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELTON",
        "first_name": "ALEXIS",
        "middle_name": "CARRIE",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-10",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE61558951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyra Peerenboom
• Kathryn Laurene Peil
• Sotheary Pel, PHARMACIST
• Misty Geneine Pelagalli, RC
• Robin Lysane Pelletier, PT, MPT
• Joylynn Comia Penaloza, PSY.D., LMHC
• Kathryn Pence, PA-C
• Cosmo Yuchen Peng, DDS
• Doris T Peng, PHARMACIST
• Anna Pengra, MAT, LAT

• Dentist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; 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.