Active NPI
Ashish Kukreja, D.D.S.
- Periodontics
- Fayetteville, GA
National Provider Identifier
1447473947
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DN013129
- Practice address
- 570 W Lanier Ave
Fayetteville, GA 30214-7649 - Phone
- (678) 836-2128
- Fax
- (770) 441-0299
- NPI assigned
- Apr 11, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DN013129 | GA | Primary |
Addresses
Primary practice location
570 W Lanier Ave
Fayetteville, GA 30214-7649
Mailing address
451 Harold Ave NE
Atlanta, GA 30307-1739
Phone (504) 914-8748
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160219001883 | GA | Order and Referring Only - Other (Non-Physician) | 0648575209 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1447473947",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "451 HAROLD AVE NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303071739",
"telephone_number": "504-914-8748",
"fax_number": "770-441-0299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "570 W LANIER AVE",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "302147649",
"telephone_number": "678-836-2128",
"fax_number": "770-441-0299"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUKREJA",
"first_name": "ASHISH",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "GA",
"license": "DN013129",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, GA
- Aubry Ireland Kochera, RN, FNP-C
- Kokua Community Services LLC (Synergy HomeCare of Fayetteville Ga LLC)
- Kompass Transit Services LLC (Kompass Transit)
- Jason David Kranenburg, CSFA
- Kavita Perumal Krishnasamy, M.D.
- Josipa Kukucka, CRNA
- Dileep Kumar, MD
- Ramesh Kumar, M.D
- Sujith Kuruvilla, M.D
- L & a Staffing Agency, L.L.C. (L & A Homecare Services, L.L.C.)
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.