NPIMap

Everett Maynard, D.D.S.

Individual provider Active NPI Pediatric Dentistry · Casper, WY

NPI 1912347253 · NPPES record last updated Jan 25, 2016

Key facts

NPI
1912347253
Entity type
Individual (NPI type 1)
Primary specialty
Pediatric Dentistry 1223P0221X
License
1343 (WY)
Practice address
295 N Walsh Dr
Casper, WY 82609-1911
Phone
(307) 265-7878
NPI assigned
Jul 1, 2013
Sex
Male
Sole proprietor
Yes

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Denise R Prugh DDS Pediatric Dentistry Past Accepting new patients
Surfin Smiles LLC Pediatric Dentistry Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: emaynard@yourcarecommunity.org

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 7089 NE
Dentist 122300000X 7089 NE
Pediatric Dentistry 1223P0221X 1343 WY Yes

Addresses

Primary practice location

295 N Walsh Dr
Casper, WY 82609-1911

Mailing address

3361 E 18TH St
Casper, WY 82609-3513

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 25, 2016.

{
    "created_epoch": "1372636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453680000000",
    "number": "1912347253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3361 E 18TH ST",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826093513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 N WALSH DR",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826091911",
            "telephone_number": "307-265-7878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYNARD",
        "first_name": "EVERETT",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-01",
        "last_updated": "2016-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NE",
            "license": "7089",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NE",
            "license": "7089",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WY",
            "license": "1343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Casper, WY

All providers in Casper, WY · Pediatric Dentistry in Wyoming

Sources for this page

Verify at the official NPI Registry.