Individual provider Active NPI

Reza B. Kazemi, D.M.D.

  • General Practice Dentistry
  • Farmington, CT
National Provider Identifier
1386856987
Registry record updated Apr 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
007555 Issued in CT
Practice address
263 Farmington Avenue
University Dentists
Farmington, CT 06030-2820
Phone
(860) 679-3170
Fax
(860) 679-8162
NPI assigned
May 4, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 007555 CT Primary

Addresses

Primary practice location

263 Farmington Avenue
University Dentists
Farmington, CT 06030-2820

Mailing address

263 Farmington Avenue
University Dentists
Farmington, CT 06030-2820
Phone (860) 679-3170

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150306000884 CT Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 4082930201

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
007555CTMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365379200000",
    "number": "1386856987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVENUE",
            "address_2": "UNIVERSITY DENTISTS",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060302820",
            "telephone_number": "860-679-3170",
            "fax_number": "860-679-8162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVENUE",
            "address_2": "UNIVERSITY DENTISTS",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060302820",
            "telephone_number": "860-679-3170",
            "fax_number": "860-679-8162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAZEMI",
        "first_name": "REZA",
        "middle_name": "B.",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-04",
        "last_updated": "2013-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "007555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

Verify at the official NPI Registry.