Rachael H Tingen, DMD
Individual provider Active NPI Dentist · Placitas, NM
NPI 1922084201 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1922084201
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DD2324 (NM)
- Practice address
- 3 Homesteads Rd
BLDG. B
Placitas, NM 87043 - Phone
- (505) 771-1122
- Fax
- (505) 771-1144
- NPI assigned
- Dec 19, 2005
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160913002781 | NM | Order and Referring Only - Other (Physician) |
0446546659 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD2324 | NM | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DD2324 | NM | Yes |
Addresses
Primary practice location
3 Homesteads Rd
BLDG. B
Placitas, NM 87043
Mailing address
3 Homesteads Rd
BLDG. B
Placitas, NM 87043
Phone (505) 771-1122
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DD2324 | Other | NM | DENTAL LICENSE |
Other providers in Placitas, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.