Active NPI
Kyle Michael Maldonado, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Hammond, LA
National Provider Identifier
1174053243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 6781
- Practice address
- 808 C M Fagan Dr
Hammond, LA 70403 - Phone
- (985) 542-8719
- NPI assigned
- Jun 12, 2017
- 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 | 6781 | LA | Primary |
Addresses
Primary practice location
808 C M Fagan Dr
Hammond, LA 70403
Mailing address
808 C M Fagan Dr
Hammond, LA 70403-6049
Phone (985) 542-8719
Other practice location 1
1100 Florida Ave
New Orleans, LA 70119-2715
Phone (504) 615-7363
Other practice location 2
1100 Florida Ave
New Orleans, LA 70119-2715
Phone (504) 615-7363
Other practice location 3
4432 Conlin St Ste 2B
Metairie, LA 70006-2146
Phone (504) 455-5581
Other practice location 4
10900 Highway 3125 Ste C
Lutcher, LA 70071-5639
Phone (225) 869-3753
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 |
|---|---|---|---|
| 6781 | LA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569283200000",
"number": "1174053243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "808 C M FAGAN DR",
"city": "HAMMOND",
"state": "LA",
"postal_code": "704036049",
"telephone_number": "985-542-8719"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "808 C M FAGAN DR",
"city": "HAMMOND",
"state": "LA",
"postal_code": "70403",
"telephone_number": "985-542-8719"
}
],
"practiceLocations": [
{
"address_1": "1100 Florida Ave",
"address_purpose": "LOCATION",
"city": "New Orleans",
"state": "LA",
"postal_code": "701192715",
"country_code": "US",
"telephone_number": "504-615-7363",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1100 Florida Ave",
"address_purpose": "LOCATION",
"city": "New Orleans",
"state": "LA",
"postal_code": "701192715",
"country_code": "US",
"telephone_number": "504-615-7363",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4432 Conlin St Ste 2B",
"address_purpose": "LOCATION",
"city": "Metairie",
"state": "LA",
"postal_code": "700062146",
"country_code": "US",
"telephone_number": "504-455-5581",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "10900 Highway 3125 Ste C",
"address_purpose": "LOCATION",
"city": "Lutcher",
"state": "LA",
"postal_code": "700715639",
"country_code": "US",
"telephone_number": "225-869-3753",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MALDONADO",
"first_name": "KYLE",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-06-12",
"last_updated": "2019-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "LA",
"license": "6781",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hammond, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.