Active NPI
Khaled Altabtbaei
- Dentist
- Columbus, OH
National Provider Identifier
1376940213
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- RES.3377
- Practice address
- 305 W 12TH Ave
2ND Floor, Graduate Resident Periodontology Clinics
Columbus, OH 43210-1267 - Phone
- (614) 688-3763
- NPI assigned
- Nov 20, 2014
- 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 | RES.3377 | OH | Primary |
Addresses
Primary practice location
305 W 12TH Ave
2ND Floor, Graduate Resident Periodontology Clinics
Columbus, OH 43210-1267
Mailing address
305 W 12TH Ave
Department of Periodontology, 4TH Floor
Columbus, OH 43210-1267
Phone (614) 292-0371
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 |
|---|---|---|---|
| RES.3377 | OH | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1431302400000",
"number": "1376940213",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 W 12TH AVE",
"address_2": "DEPARTMENT OF PERIODONTOLOGY, 4TH FLOOR",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432101267",
"telephone_number": "614-292-0371",
"fax_number": "614-292-4612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 W 12TH AVE",
"address_2": "2ND FLOOR, GRADUATE RESIDENT PERIODONTOLOGY CLINICS",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432101267",
"telephone_number": "614-688-3763"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALTABTBAEI",
"first_name": "KHALED",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-11-20",
"last_updated": "2015-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "RES.3377",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.