Active NPI
Marilyn Vigil Ketcham, DDS
- Dentist
- Denver, CO
National Provider Identifier
1881790509
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6990
- Practice address
- 3800 York St
Denver, CO 80205-3540 - Phone
- (303) 296-4873
- NPI assigned
- Sep 16, 2006
- Last updated
- Sep 6, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | DD2546 | NM | |
| Dentist | 122300000X | 6990 | CO | Primary |
Addresses
Primary practice location
3800 York St
Denver, CO 80205-3540
Mailing address
3800 York St
Denver, CO 80205-3540
Phone (303) 296-4873
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6990 | Other | CO | COLORADO DENTAL LICENSE |
| DD2546 | Other | NM | DENTAL STATE LICENSE |
| 02069904 | Medicaid | CO | |
| 87384043 | Medicaid | NM | |
| CS00210277 | Other | NM | BOARD OF PHARMACY NUMBER |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6990 | CO | MD | Dentist |
| DD2546 | NM | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315267200000",
"number": "1881790509",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3800 YORK ST",
"city": "DENVER",
"state": "CO",
"postal_code": "802053540",
"telephone_number": "303-296-4873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3800 YORK ST",
"city": "DENVER",
"state": "CO",
"postal_code": "802053540",
"telephone_number": "303-296-4873"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETCHAM",
"first_name": "MARILYN",
"middle_name": "VIGIL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-16",
"last_updated": "2011-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NM",
"license": "DD2546",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "6990",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COLORADO DENTAL LICENSE",
"identifier": "6990",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL STATE LICENSE",
"identifier": "DD2546",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02069904",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "87384043",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF PHARMACY NUMBER",
"identifier": "CS00210277",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Denver, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.