Individual provider Active NPI

Cyanka L Dsouza, DMD

  • General Practice Dentistry
  • New Haven, CT
National Provider Identifier
1104268002
Registry record updated Jul 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
11005 Issued in CT
Practice address
531 Elm St
New Haven, CT 06511-4549
Phone
(203) 583-4707
NPI assigned
Jul 22, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 11005 CT Primary

Addresses

Primary practice location

531 Elm St
New Haven, CT 06511-4549

Mailing address

1090 Northchase Pkwy SE Ste 290
Marietta, GA 30067-6402
Phone (770) 916-5352

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20181030001358 CT Order and Referring Only - DentistPractitioner - Dentist 2365795804

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11005CTMDSocial Worker

NPI Registry JSON

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

{
    "created_epoch": "1374451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374451200000",
    "number": "1104268002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 NORTHCHASE PKWY SE STE 290",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300676402",
            "telephone_number": "770-916-5352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "531 ELM ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065114549",
            "telephone_number": "203-583-4707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DSOUZA",
        "first_name": "CYANKA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-22",
        "last_updated": "2013-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "11005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.