Active NPI
Rahadian Kris Putrasahan, DDS
- General Practice Dentistry
- Chandler, AZ
National Provider Identifier
1083700967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4695
- Practice address
- 3195 W Ray Rd
Suite #3
Chandler, AZ 85226-2417 - Phone
- (480) 788-3627
- NPI assigned
- Oct 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4695 | AZ | Primary |
Addresses
Primary practice location
3195 W Ray Rd
Suite #3
Chandler, AZ 85226-2417
Mailing address
7650 S McClintock Dr
Suite 103-235
Tempe, AZ 85284-1672
Phone (480) 788-3627
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4695 | AZ | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311120000000",
"number": "1083700967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7650 S MCCLINTOCK DR",
"address_2": "SUITE 103-235",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852841672",
"telephone_number": "480-788-3627"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3195 W RAY RD",
"address_2": "SUITE #3",
"city": "CHANDLER",
"state": "AZ",
"postal_code": "852262417",
"telephone_number": "480-788-3627"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUTRASAHAN",
"first_name": "RAHADIAN",
"middle_name": "KRIS",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-05",
"last_updated": "2011-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AZ",
"license": "4695",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chandler, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.