Individual provider Active NPI

Harry E Tatoian Jr., D.M.D.

  • Dentist
  • Roanoke, VA
National Provider Identifier
1972634921
Registry record updated Aug 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401414742 Issued in VA
Practice address
3716 Melrose Ave NW
Roanoke, VA 24017-2716
Phone
(540) 362-0360
NPI assigned
Mar 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 11936 MA
Dentist 122300000X 0401414742 VA Primary

Addresses

Primary practice location

3716 Melrose Ave NW
Roanoke, VA 24017-2716

Mailing address

PO Box 3475
Pawleys Island, SC 29585-3475
Phone (781) 964-1233

Other identifiers 2

IdentifierTypeStateIssuer
0271071MedicaidMA
00000179289OtherMAUNITED CONCORDIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191113000740 VA Order and Referring Only - DentistPractitioner - Dentist 7719319714

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11936MAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565827200000",
    "number": "1972634921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3475",
            "city": "PAWLEYS ISLAND",
            "state": "SC",
            "postal_code": "295853475",
            "telephone_number": "781-964-1233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3716 MELROSE AVE NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240172716",
            "telephone_number": "540-362-0360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATOIAN",
        "first_name": "HARRY",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-08",
        "last_updated": "2019-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "11936",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401414742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0271071",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "00000179289",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.