Active NPI
Paul Russel Kodet, DDS
- Dentist
- Auburn, CA
National Provider Identifier
1417065293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 25813
- Practice address
- 185 Palm Ave
Auburn, CA 95603-3711 - Phone
- (530) 885-6559
- Fax
- (530) 885-6550
- NPI assigned
- Aug 29, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | 25813 | CA | Primary |
Addresses
Primary practice location
185 Palm Ave
Auburn, CA 95603-3711
Mailing address
185 Palm Ave
Auburn, CA 95603-3711
Phone (530) 885-6559
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25813 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jesse Whitely DDS, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Auburn, CA
- NPI 1972081545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417065293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "185 PALM AVE",
"city": "AUBURN",
"state": "CA",
"postal_code": "956033711",
"telephone_number": "530-885-6559",
"fax_number": "530-885-6550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "185 PALM AVE",
"city": "AUBURN",
"state": "CA",
"postal_code": "956033711",
"telephone_number": "530-885-6559",
"fax_number": "530-885-6550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KODET",
"first_name": "PAUL",
"middle_name": "RUSSEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "25813",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Auburn, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.