Individual provider Active NPI

Erol J. Kanli, D.D.S.

  • Dentist
  • Springfield, VA
National Provider Identifier
1457672420
Registry record updated Jun 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0101412835 Issued in VA
Practice address
6116 Rolling Rd
Suite 316
Springfield, VA 22152-1521
Phone
(703) 451-8332
Fax
(703) 451-4661
NPI assigned
Jun 14, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 0101412835 VA Primary

Addresses

Primary practice location

6116 Rolling Rd
Suite 316
Springfield, VA 22152-1521

Mailing address

6116 Rolling Rd
Suite 316
Springfield, VA 22152-1521
Phone (703) 451-8332

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20251231002066 NC Practitioner - Dentist 0143532663 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dentist
Education
Howard University College of Dentistry, 1999
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1885 FM
2673 Unit 146
Canyon Lake, TX 78133

1885 FM 2673 Unit
Suite 146
Canyon Lake, TX 78133-4765

284 Tadpole LN
Taylorsville, NC 28681-8050

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0101412835VAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
SDC KL LLC CurrentSince Sep 5, 2023 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.

NPI Registry JSON

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

{
    "created_epoch": "1276473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276473600000",
    "number": "1457672420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6116 ROLLING RD",
            "address_2": "SUITE 316",
            "city": "SPRINGFIELD",
            "state": "VA",
            "postal_code": "221521521",
            "telephone_number": "703-451-8332",
            "fax_number": "703-451-4661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6116 ROLLING RD",
            "address_2": "SUITE 316",
            "city": "SPRINGFIELD",
            "state": "VA",
            "postal_code": "221521521",
            "telephone_number": "703-451-8332",
            "fax_number": "703-451-4661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANLI",
        "first_name": "EROL",
        "middle_name": "J.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-14",
        "last_updated": "2010-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0101412835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, VA

Sources for this page

Verify at the official NPI Registry.