Active NPI
Sujata Pradhan-Peck
- Dentist
- Bethel, CT
National Provider Identifier
1285912410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 010774
- Practice address
- 24 Grassy Plain St
Bethel, CT 06801-1700 - Phone
- (203) 616-5786
- NPI assigned
- Jul 21, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019028782 | IL | |
| Dentist | 122300000X | 010774 | CT | Primary |
Addresses
Primary practice location
24 Grassy Plain St
Bethel, CT 06801-1700
Mailing address
24 Grassy Plain St
Bethel, CT 06801-1700
Phone (203) 616-5786
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 |
|---|---|---|---|
| 019028782 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elite Dental Care | Dentist | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Dentist
- Bethel, CT
- NPI 1679960280
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432166400000",
"number": "1285912410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 GRASSY PLAIN ST",
"city": "BETHEL",
"state": "CT",
"postal_code": "068011700",
"telephone_number": "203-616-5786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 GRASSY PLAIN ST",
"city": "BETHEL",
"state": "CT",
"postal_code": "068011700",
"telephone_number": "203-616-5786"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRADHAN-PECK",
"first_name": "SUJATA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-21",
"last_updated": "2015-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019028782",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CT",
"license": "010774",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bethel, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.