Active NPI
Rosalyn Sulyanto
- Pediatric Dentistry
- Columbus, OH
National Provider Identifier
1174818066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DN1855702
- Practice address
- 700 Childrens Dr
Columbus, OH 43205-2664 - Phone
- (614) 355-0777
- NPI assigned
- Jun 20, 2011
- Last updated
- Jun 24, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN1855702 | MA | |
| Dentist | 122300000X | RES.3114 | OH | |
| Pediatric Dentistry | 1223P0221X | DN1855702 | MA | Primary |
Addresses
Primary practice location
700 Childrens Dr
Columbus, OH 43205-2664
Mailing address
100 E Gay St Unit 203
Columbus, OH 43215-3169
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 |
|---|---|---|---|
| DN1855702 | MA | MD | Dentist |
| RES.3114 | OH | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| BCH Dental Group | Pediatric Dentistry | Past | Accepting new patients |
Interoperability endpoints
- rsulyanto27168@direct.bostonchildrens.org
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Pediatric Dentistry
- Boston, MA
- NPI 1699876318
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372032000000",
"number": "1174818066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 E GAY ST UNIT 203",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432153169"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 CHILDRENS DR",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432052664",
"telephone_number": "614-355-0777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULYANTO",
"first_name": "ROSALYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-20",
"last_updated": "2013-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DN1855702",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "RES.3114",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MA",
"license": "DN1855702",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.