Individual provider Active NPI

Larre L Betsworth, D.D.S.

  • General Practice Dentistry
  • Topeka, KS
National Provider Identifier
1861497067
Registry record updated Nov 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6550 Issued in KS
Practice address
2301 SW 6TH Ave
Topeka, KS 66606-1759
Phone
(785) 233-1162
Fax
(785) 233-4169
NPI assigned
Jun 15, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 15, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 6550 KS Primary

Addresses

Primary practice location

2301 SW 6TH Ave
Topeka, KS 66606-1759

Mailing address

2301 SW 6TH Ave
Topeka, KS 66606-1759
Phone (785) 233-1162

Other identifiers 2

IdentifierTypeStateIssuer
785405OtherUNITED CONCORDIA-TRICARE
22957OtherKSBLUECROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
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

Enrollment IDStateProvider typePAC IDDetails
I20150108000144 KS Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 4587987003

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6550KSMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289779200000",
    "number": "1861497067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 SW 6TH AVE",
            "city": "TOPEKA",
            "state": "KS",
            "postal_code": "666061759",
            "telephone_number": "785-233-1162",
            "fax_number": "785-233-4169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 SW 6TH AVE",
            "city": "TOPEKA",
            "state": "KS",
            "postal_code": "666061759",
            "telephone_number": "785-233-1162",
            "fax_number": "785-233-4169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETSWORTH",
        "first_name": "LARRE",
        "middle_name": "L",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-15",
        "last_updated": "2010-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KS",
            "license": "6550",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA-TRICARE",
            "identifier": "785405",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUE SHIELD",
            "identifier": "22957",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Topeka, KS

Sources for this page

Verify at the official NPI Registry.