Gideon Prasanth Kodali, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D11813 Issued in OR

Practice address

15715 NW Central Dr Ste 7
Portland, OR 97229-1267

Phone

(503) 610-4038

NPI assigned

Jul 7, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1688688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688688000000",
    "number": "1194403485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6334 SE IMAGINE WAY",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971235059",
            "telephone_number": "270-363-5624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15715 NW CENTRAL DR STE 7",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972291267",
            "telephone_number": "503-610-4038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KODALI",
        "first_name": "GIDEON PRASANTH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-07",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D11813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dora Marie Kocs-Meyers
• Melinda Kocsis, LPN
• Katherine Kocurek, ROLFER, LMT
• Emi A Koda, DO
• Katalin Koda, LCSW
• Michele Karen Koder, PHARM.D.
• Megan Anntonia Koehle, MD
• Katie Zenith Koehler Esser, LCSW
• Jeremy Koehler
• Patricia Ann Koehler, P.T.

• Dentist in Portland, OR
• Providers in Portland, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.