Active NPI
Kenneth John Agronin, DDS MSD
- Orthodontics and Dentofacial Orthopedics Dentistry
- Berea, OH
National Provider Identifier
1104981794
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 16649
- Practice address
- 359 Front St
Berea, OH 44017 - Phone
- (440) 234-4200
- Fax
- (440) 979-9407
- NPI assigned
- Dec 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 16649 | OH | Primary |
Addresses
Primary practice location
359 Front St
Berea, OH 44017
Mailing address
359 Front St
Berea, OH 44017
Phone (440) 234-4200
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 |
|---|---|---|---|
| 16649 | OH | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484784000000",
"number": "1104981794",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "359 FRONT ST",
"city": "BEREA",
"state": "OH",
"postal_code": "44017",
"telephone_number": "440-234-4200",
"fax_number": "440-979-9407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "359 FRONT ST",
"city": "BEREA",
"state": "OH",
"postal_code": "44017",
"telephone_number": "440-234-4200",
"fax_number": "440-979-9407"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGRONIN",
"first_name": "KENNETH",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "DDS MSD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-26",
"last_updated": "2017-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "OH",
"license": "16649",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berea, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.