Tyler Haradon

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

204636 Issued in CO

Practice address

685 Citadel Dr E Ste 200a
Colorado Springs, CO 80909-5315

Phone

(719) 574-4867

NPI assigned

Jun 24, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Freelance Anesthesia Colorado LLC

  • Certified Registered Nurse Anesthetist
  • Parker, CO
  • NPI 1790229193
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624492800000",
    "number": "1972173706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "685 CITADEL DR E STE 200A",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809095315",
            "telephone_number": "719-574-4867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "685 CITADEL DR E STE 200A",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809095315",
            "telephone_number": "719-574-4867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARADON",
        "first_name": "TYLER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-24",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CO",
            "license": "204636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER",
            "identifier": "7195744867",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.rmperiohealth.com",
            "affiliation": "N",
            "address_1": "685 Citadel Dr E Ste 200A",
            "city": "Colorado Springs",
            "state": "CO",
            "country_code": "US",
            "postal_code": "809095315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Happy Lives LLC
• Kelly Denise Haptonstall, RDH
• Hara Transportation LLC
• Stephanie Walker Harabaglia, D.O., M.S.
• Geoffrey Haradon, DDS
• Jeffrey Harazin
• Kimberly Harbaugh
• Richard Glenn Harbison, M.D.
• Harbor House Collaborative
• Kathryn Harbour, RBT

• Periodontics in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Periodontics in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.