Ioannis Koutlas, DDS

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

D11102 Issued in MN

Practice address

515 Delaware St SE
16-116 Moos Tower
Minneapolis, MN 55455-0357

Phone

(612) 626-5844

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Oral SurgeryAlso: Pathology

Education

University of Minnesota School of Dentistry, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Regents of the University of Minnesota

  • Federally Qualified Health Center (FQHC)
  • Minneapolis, MN
  • NPI 1114019858
  NPD
• Regents of the University of Minnesota

  • Clinic Pharmacy
  • Minneapolis, MN
  • NPI 1528288875
  NPD
• Regents of the University of Minnesota

  • Clinical Medical Laboratory
  • Minneapolis, MN
  • NPI 1962572784
  NPD

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447361332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 DELAWARE ST SE",
            "address_2": "16-116 MOOS TOWER",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550357",
            "telephone_number": "612-626-5844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 DELAWARE ST SE",
            "address_2": "16-116 MOOS TOWER",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550357",
            "telephone_number": "612-626-5844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUTLAS",
        "first_name": "IOANNIS",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "MN",
            "license": "D11102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Kough, RN
• Despoina Koukousaki, MD
• Lydia Kouletsis, PHARMD
• Vessela M Kouneva
• Anne Marie Kouri, M.D.
• Christina Koutsari, PHARMD
• Jessica Erin Kovacevich, MOTR
• Christopher James Kovaleski
• Kovanda Aesthetic Surgery
• Timothy James Kovanda

• Oral and Maxillofacial Pathology Dentistry in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Oral and Maxillofacial Pathology Dentistry in Minnesota

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.