Active NPI
Garry Vangenderen, DDS
- General Practice Dentistry
- La Junta, CO
National Provider Identifier
1871982140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DDS108583
- Practice address
- 17 W 4TH St
La Junta, CO 81050-3636 - Phone
- (719) 383-2083
- NPI assigned
- Jan 9, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DEN.00202413 | CO | |
| General Practice Dentistry | 1223G0001X | DDS108583 | CA | Primary |
Addresses
Primary practice location
17 W 4TH St
La Junta, CO 81050-3636
Mailing address
330 The Village Drive
Apt 112
Redondo Beach, CA 90277
Phone (201) 214-3838
Other practice location 1
962 Sepulveda Blvd
Harbor City, CA 90710-1405
Phone (310) 539-3245
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 |
|---|---|---|---|
| DDS108583 | CA | MD | General Practice Dentistry |
| DEN.00202413 | CO | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walter Jefferson Dental Corporation | General Practice | Past | Accepting new patients |
| Down to Earth Dentistry, LLC. | General Practice | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Practice Dentistry
- La Junta, CO
- NPI 1730506809
General Practice
-
- General Practice Dentistry
- Harbor City, CA
- NPI 1437700952
General Practice
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1420761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680480000000",
"number": "1871982140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 THE VILLAGE DRIVE",
"address_2": "APT 112",
"city": "REDONDO BEACH",
"state": "CA",
"postal_code": "90277",
"telephone_number": "201-214-3838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 W 4TH ST",
"city": "LA JUNTA",
"state": "CO",
"postal_code": "810503636",
"telephone_number": "719-383-2083"
}
],
"practiceLocations": [
{
"address_1": "962 Sepulveda Blvd",
"address_purpose": "LOCATION",
"city": "Harbor City",
"state": "CA",
"postal_code": "907101405",
"country_code": "US",
"telephone_number": "310-539-3245",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VANGENDEREN",
"first_name": "GARRY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-01-09",
"last_updated": "2023-04-03",
"certification_date": "2023-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CO",
"license": "DEN.00202413",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "DDS108583",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Junta, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.