Edward Anthony Koditek, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DEN.00007696 Issued in CO

Practice address

230 Chatham Dr
Colorado Springs, CO 80906-4868

Phone

(719) 576-8985

NPI assigned

May 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other names 1

• Dr. Edward Anthony Koditek Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1146873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431648000000",
    "number": "1346299690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 CHATHAM DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809064868",
            "telephone_number": "719-576-8985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 CHATHAM DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809064868",
            "telephone_number": "719-576-8985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KODITEK",
        "first_name": "EDWARD",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-06",
        "last_updated": "2015-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "7696",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "24563",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "DEN.00007696",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "DEN-7696",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EDWARD",
            "last_name": "KODITEK",
            "middle_name": "ANTHONY",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jaylynne S Koch, PHD, LPC, RPT-S
• Kristina Marie Koch, MPT
• Stefan Matthew Kochis, O.D.
• Koco-Para Medical Services LLC
• Jody Kocsis
• Hope Koebel
• Amme Lynn Koehler
• Sara Koehler, M.S. CCC-SLP
• Sarah Koehler, RD
• Gerard G Koehn, M.D.

• Dentist in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 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.

Verify at the official NPI Registry.