Active NPI
Emma J Koukol, DDS
- Endodontics
- Acton, MA
National Provider Identifier
1114148475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 13959
- Practice address
- 411 Massachusetts Ave
Suite 203
Acton, MA 01720-3739 - Phone
- (978) 263-1154
- Fax
- (978) 263-1155
- NPI assigned
- May 2, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 13959 | MA | Primary |
Addresses
Primary practice location
411 Massachusetts Ave
Suite 203
Acton, MA 01720-3739
Mailing address
411 Massachusetts Ave
Suite 203
Acton, MA 01720-3739
Phone (978) 263-1154
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 |
|---|---|---|---|
| 13959 | MA | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| S.Y. Wang, D.M.D., P.C. | Endodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114148475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 MASSACHUSETTS AVE",
"address_2": "SUITE 203",
"city": "ACTON",
"state": "MA",
"postal_code": "017203739",
"telephone_number": "978-263-1154",
"fax_number": "978-263-1155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 MASSACHUSETTS AVE",
"address_2": "SUITE 203",
"city": "ACTON",
"state": "MA",
"postal_code": "017203739",
"telephone_number": "978-263-1154",
"fax_number": "978-263-1155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOUKOL",
"first_name": "EMMA",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "MA",
"license": "13959",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Acton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.