Active NPI
Chris David Kutanovski, D.D.S, M.S.D
- Endodontics
- Indianapolis, IN
National Provider Identifier
1134489198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 12011791A
- Practice address
- 8782 Madison Ave
Indianapolis, IN 46227-7202 - Phone
- (317) 882-2882
- NPI assigned
- May 24, 2012
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 12011791A | IN | Primary |
Addresses
Primary practice location
8782 Madison Ave
Indianapolis, IN 46227-7202
Mailing address
8782 Madison Ave
Indianapolis, IN 46227-7202
Phone (219) 613-3846
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160914001000 | IN | Order and Referring Only - Other (Physician) | 1254627599 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658102400000",
"number": "1134489198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8782 MADISON AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462277202",
"telephone_number": "219-613-3846"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8782 MADISON AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462277202",
"telephone_number": "317-882-2882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUTANOVSKI",
"first_name": "CHRIS",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "D.D.S, M.S.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-05-24",
"last_updated": "2022-07-18",
"certification_date": "2022-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, Endodontics",
"state": "IN",
"license": "12011791A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.