South Windsor Perio, PLLC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

SOUTH WINDSOR PERIO, PLLC

Practice address

469 Buckland Rd Ste 203
South Windsor, CT 06074-3737

Phone

(860) 644-2340

NPI assigned

Jun 1, 2023

Last updated

Jun 1, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Michael Kang, DDSNPI 1417335142

Title

Owner/Manager

Phone

(847) 714-6929

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Doo Hyun Kang, DDS

  • Periodontics
  • South Windsor, CT
  • NPI 1417335142
  NPD Authorized official

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

{
    "created_epoch": "1685577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685577600000",
    "number": "1336832641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "469 BUCKLAND RD STE 203",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060743737",
            "telephone_number": "860-644-2340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "469 BUCKLAND RD STE 203",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060743737",
            "telephone_number": "860-644-2340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH WINDSOR PERIO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-01",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A",
        "authorized_official_last_name": "KANG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "847-714-6929",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Windsor Ambulance Corps Inc
• South Windsor Ambulatory Care Ctr Inc
• South Windsor Board of Education
• South Windsor Neck and Back, LLC
• South Windsor Pediatrics, LLC
• Southwindsorpsychotherapy (Timothy Jeski, LCSW)
• Rose M Spada
• Wendy Sperry, FNP
• Tanya Anne Spiller, RPH
• Stacy Joanne Spiro, MD

• Periodontics in South Windsor, CT
• Providers in South Windsor, CT by specialty
• Periodontics in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.