Active NPI
Sogol Davari
- Dentist
- La Grange, KY
National Provider Identifier
1144055831
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 11223
- Practice address
- 2005 S Highway 53
La Grange, KY 40031-9109 - Phone
- (502) 225-0074
- NPI assigned
- Sep 3, 2024
- Last updated
- Sep 3, 2024
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 11223 | KY | Primary |
Addresses
Primary practice location
2005 S Highway 53
La Grange, KY 40031-9109
Mailing address
825 Clarks LN
Louisville, KY 40217-2440
Phone (502) 836-6001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- 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 |
|---|---|---|---|---|
| I20241023004141 | KY | Order and Referring Only - Dentist | 2365975778 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11223 | KY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1725321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725321600000",
"number": "1144055831",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "825 CLARKS LN",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402172440",
"telephone_number": "502-836-6001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2005 S HIGHWAY 53",
"city": "LA GRANGE",
"state": "KY",
"postal_code": "400319109",
"telephone_number": "502-225-0074"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVARI",
"first_name": "SOGOL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-09-03",
"last_updated": "2024-09-03",
"certification_date": "2024-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "11223",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Grange, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2024; 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.