Active NPI
Dorjan Kodra, RDH
- Dental Hygienist
- Wolcott, CT
National Provider Identifier
1124657945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 008224
- Practice address
- 78 Chesterfield Ave
Wolcott, CT 06716-3225 - Phone
- (203) 217-7582
- NPI assigned
- Apr 3, 2020
- 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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 008224 | CT | Primary |
Addresses
Primary practice location
78 Chesterfield Ave
Wolcott, CT 06716-3225
Mailing address
78 Chesterfield Ave
Wolcott, CT 06716-3225
Phone (203) 217-7582
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 |
|---|---|---|---|
| 008224 | CT | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585872000000",
"number": "1124657945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "78 CHESTERFIELD AVE",
"city": "WOLCOTT",
"state": "CT",
"postal_code": "067163225",
"telephone_number": "203-217-7582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "78 CHESTERFIELD AVE",
"city": "WOLCOTT",
"state": "CT",
"postal_code": "067163225",
"telephone_number": "203-217-7582"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KODRA",
"first_name": "DORJAN",
"name_prefix": "Mr.",
"credential": "RDH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-04-03",
"last_updated": "2020-04-03",
"certification_date": "2020-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "CT",
"license": "008224",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wolcott, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.