Austin Tyler Eddy, DMD
Individual provider Active NPI Dentist · Chaparral, NM
NPI 1962081471 · NPPES record last updated Nov 16, 2023
Key facts
- NPI
- 1962081471
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 00205514 (CO)
- Practice address
- 510 E Lisa Dr
Chaparral, NM 88081-7809 - Phone
- (575) 824-0128
- Fax
- (575) 824-0179
- NPI assigned
- Apr 3, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00205514 | CO | MD | Dentist |
| DD5457 | NM | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Austin T Eddy DMD PLLC | Current | Accepting new patients |
Locations
115 N Beech St
Cortez, CO 81321
Phone (970) 565-4448
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DD5457 | NM | |
| Dentist | 122300000X | 00205514 | CO | Yes |
Addresses
Primary practice location
510 E Lisa Dr
Chaparral, NM 88081-7809
Mailing address
115 N Beech St
Cortez, CO 81321-3207
Phone (970) 565-7275
Other practice location 1
115 N Beech St
Cortez, CO 81321
Phone (435) 590-1795
Other providers in Chaparral, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.