Joseph Kalani Ahlo, DMD
Individual provider Active NPI Periodontics · Freeport, NY
NPI 1225291990 · NPPES record last updated Oct 18, 2010
Key facts
- NPI
- 1225291990
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Periodontics 1223P0300X
- License
- 052312-1 (NY)
- Practice address
- 396 Atlantic Ave
Freeport, NY 11520-5217 - Phone
- (516) 378-1968
- NPI assigned
- Jul 3, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160721002570 | NJ | Order and Referring Only - Other (Physician) |
3274826631 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 052312-1 | NY | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Atlas Dental Group | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 052312-1 | NY | Yes |
Addresses
Primary practice location
396 Atlantic Ave
Freeport, NY 11520-5217
Mailing address
396 Atlantic Ave
Freeport, NY 11520-5217
Phone (617) 905-2856
Other providers in Freeport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.