Siddesh Palani Ponnapakkam, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

7589 Issued in LA

Practice address

3201 S Carrollton Ave
New Orleans, LA 70118-4307

Phone

(504) 207-3060

NPI assigned

Jul 6, 2024

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

Enrolled in LA

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

Practice roles

Locations

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.

• Marillac Community Health Centers

  • Primary Care Clinic/Center
  • Metairie, LA
  • NPI 1396059796
  Medicare reassignment NPD
• Marillac Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Kenner, LA
  • NPI 1457802332
  NPD
• Marillac Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Hammond, LA
  • NPI 1578442505
  NPD
• Marillac Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • New Orleans, LA
  • NPI 1780935973
  NPD (past)

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

{
    "created_epoch": "1720224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720224000000",
    "number": "1215773486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4824 PIKE DR",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700032728",
            "telephone_number": "504-330-3865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 S CARROLLTON AVE",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701184307",
            "telephone_number": "504-207-3060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONNAPAKKAM",
        "first_name": "SIDDESH",
        "middle_name": "PALANI",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-06",
        "last_updated": "2024-07-06",
        "certification_date": "2024-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "LA",
            "license": "7589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barry Douglas Pollock, PH.D
• Lyla Rose Polon
• Alexander Polski, MD
• Lucido Luciano Ponce Mejia, M.D.
• Brooke Ponder, LOTR
• Claire Ponson
• Nia Ponson, M.S., CCC-SLP
• Mattie Pontiff, DPT, OCS
• Ishna Poojary-Hohman, M.D.
• Danecia Poole

• Dentist in New Orleans, LA
• Providers in New Orleans, LA by specialty
• Dentist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 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.

Verify at the official NPI Registry.