Vladimir Vader, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D009767 Issued in AZ

Practice address

15301 Warren Shingle Rd
Beale AFB, CA 95903-1905

Phone

(530) 634-4662

NPI assigned

May 11, 2017

Last updated

Jul 6, 2023By the provider in NPPES

Sex

Male

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 NV

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

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1871020636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15301 WARREN SHINGLE RD",
            "city": "BEALE AFB",
            "state": "CA",
            "postal_code": "959031905",
            "telephone_number": "530-634-4662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15301 WARREN SHINGLE RD",
            "city": "BEALE AFB",
            "state": "CA",
            "postal_code": "959031905",
            "telephone_number": "530-634-4662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VADER",
        "first_name": "VLADIMIR",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-05-11",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D009767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meredith Studer, DPT
• Amanda Sturman
• Rebecca Lynne Thompson, LCSW
• Grant Tong, PT
• Tora Jean Tornbom, MD
• Jeffrey M Van Ness, DMD
• Richelle L Vanburen-Walls, LSW
• Lijah Vann Gardner, DO
• Paul D Vu, M.D.
• Zachary Wajvoda, PA-C

• Dentist in Beale AFB, CA
• Providers in Beale AFB, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; 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.