Active NPI
Taras Josaphat Konrad, DMD
- Dentist
- Twentynine Palms, CA
National Provider Identifier
1316930738
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS031194L
- Practice address
- McAgctc , 23Rd Dental
BLDG 1591
Twentynine Palms, CA 92278 - Phone
- (760) 830-7054
- NPI assigned
- Aug 31, 2005
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DS031194L | PA | Primary |
Addresses
Primary practice location
McAgctc , 23Rd Dental
BLDG 1591
Twentynine Palms, CA 92278
Mailing address
Nmrtc Pendleton
Oceanside, CA 92055
Phone (760) 719-4747
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 |
|---|---|---|---|
| DS031194L | PA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605830400000",
"number": "1316930738",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "NMRTC PENDLETON",
"city": "OCEANSIDE",
"state": "CA",
"postal_code": "92055",
"telephone_number": "760-719-4747"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "MCAGCTC , 23RD DENTAL",
"address_2": "BLDG 1591",
"city": "TWENTYNINE PALMS",
"state": "CA",
"postal_code": "92278",
"telephone_number": "760-830-7054"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KONRAD",
"first_name": "TARAS",
"middle_name": "JOSAPHAT",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-31",
"last_updated": "2020-11-20",
"certification_date": "2020-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS031194L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Twentynine Palms, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.