Preethi Kuknooru, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

019030943 Issued in IL

Practice address

4450 Lockhill Selma Rd Ste 101
Shavano Park, TX 78249-4394

Phone

(408) 981-4640

NPI assigned

Aug 28, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19217/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• August Dental Inc

  • General Practice Dentistry
  • Cedarpark, TX
  • NPI 1669203667
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648425600000",
    "number": "1174079305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4450 LOCKHILL SELMA RD STE 101",
            "city": "SHAVANO PARK",
            "state": "TX",
            "postal_code": "782494394",
            "telephone_number": "408-981-4640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4450 LOCKHILL SELMA RD STE 101",
            "city": "SHAVANO PARK",
            "state": "TX",
            "postal_code": "782494394",
            "telephone_number": "408-981-4640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUKNOORU",
        "first_name": "PREETHI",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-28",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "368-83",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019030943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsay Jo Kane
• Daniel Katselnik, MD
• Kimberlee Daughtry LPC PLLC
• Karen Lynn Knox, ACNS-BC, ARNP, PHD
• Jorge Augusto Kohatsu, MD
• Frank K Kuwamura III, M.D.
• Kimberly Kay Lane
• Paula R Larson, M.D.
• Shahnila Latif, M.D.
• Robert Sok Le, PHARMD

• Dentist in Shavano Park, TX
• Providers in Shavano Park, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 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.

Verify at the official NPI Registry.