Dr Theodore W Kondos DDS PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

DR THEODORE W KONDOS DDS PC

Practice address

2208 No Broadway
Poteau, OK 74953

Phone

(918) 647-8266

Fax

(918) 647-9118

NPI assigned

May 21, 2008

Organization subpart

No

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

Authorized official

Name

Theodore Nicholas Kondos, DDS

Title

Ceo DDS

Phone

(918) 647-8266

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1211328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211328000000",
    "number": "1457518060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 933",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "74953",
            "telephone_number": "918-647-8266",
            "fax_number": "918-647-9118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2208 NO BROADWAY",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "74953",
            "telephone_number": "918-647-8266",
            "fax_number": "918-647-9118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR THEODORE W KONDOS DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-21",
        "last_updated": "2008-05-21",
        "status": "A",
        "authorized_official_last_name": "KONDOS",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "NICHOLAS",
        "authorized_official_title_or_position": "CEO DDS",
        "authorized_official_telephone_number": "918-647-8266",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "973697",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Poteau, OK
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.