Individual provider Active NPI

Danielle Pannese, DDS

  • General Practice Dentistry
  • Bridgeport, CT
National Provider Identifier
1275797458
Registry record updated Jul 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
009600 Issued in CT
Practice address
968 Fairfield Ave
Bridgeport, CT 06605-1116
Phone
(203) 332-3500
Fax
(203) 382-9496
NPI assigned
Jul 16, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 009600 CT Primary

Addresses

Primary practice location

968 Fairfield Ave
Bridgeport, CT 06605-1116

Mailing address

968 Fairfield Ave
Bridgeport, CT 06605-1116
Phone (203) 332-3500

Other identifiers 1

IdentifierTypeStateIssuer
004236122MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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

Enrollment IDStateProvider typePAC IDDetails
I20160316001703 CT Order and Referring Only - DentistPractitioner - Dentist 2567768567

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
009600CTMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1216166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216166400000",
    "number": "1275797458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "968 FAIRFIELD AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066051116",
            "telephone_number": "203-332-3500",
            "fax_number": "203-382-9496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "968 FAIRFIELD AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066051116",
            "telephone_number": "203-332-3500",
            "fax_number": "203-382-9496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANNESE",
        "first_name": "DANIELLE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-16",
        "last_updated": "2008-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "009600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236122",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

Verify at the official NPI Registry.