Active NPI
Takanori Sobue, DDS
- Periodontics
- Farmington, CT
National Provider Identifier
1295995371
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 010364
- Practice address
- 263 Farmington Ave
Farmington, CT 06030-1710 - Phone
- (860) 679-2000
- NPI assigned
- Jun 12, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 010364 | CT | Primary |
Addresses
Primary practice location
263 Farmington Ave
Farmington, CT 06030-1710
Mailing address
263 Farmington Ave
Farmington, CT 06032-1956
Phone (860) 679-2000
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141204001643 | CT | Order and Referring Only - Oral Surgery | 7517289358 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010364 | CT | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421107200000",
"number": "1295995371",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "263 FARMINGTON AVE",
"city": "FARMINGTON",
"state": "CT",
"postal_code": "060321956",
"telephone_number": "860-679-2000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "263 FARMINGTON AVE",
"city": "FARMINGTON",
"state": "CT",
"postal_code": "060301710",
"telephone_number": "860-679-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOBUE",
"first_name": "TAKANORI",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-12",
"last_updated": "2015-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CT",
"license": "010364",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Farmington, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; 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.