Jesse Michael Sorrentino, D.D.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

010130 Issued in CT

Practice address

291 Farmington Ave
Farmington, CT 06032-1925

Phone

(860) 677-8747

NPI assigned

Oct 2, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1285977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285977600000",
    "number": "1427367820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "291 FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060321925",
            "telephone_number": "860-677-8747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "291 FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060321925",
            "telephone_number": "860-677-8747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SORRENTINO",
        "first_name": "JESSE",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-02",
        "last_updated": "2010-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CT",
            "license": "010130",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NY",
            "license": "0551681",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennie Song, PSY.D.
• Liansheng Song, DDS
• Thejasvee Soni, SLP
• Natalie Grace Sorial, MD
• Ryan James Sorkin, MD
• Joshua Maxwell Sorrentino, MD
• Dianna Jayne Soucier-Tagliavini, DNP, FNP-BC
• Sonia Maria Sousa
• Elise Katherine Spalla, RN
• Matthew Adam Sparks

• Periodontics in Farmington, CT
• Providers in Farmington, CT by specialty
• Periodontics in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.