Active NPI
Tejasvini Goud Jangam
- Dentist
- Bloomfield, CT
National Provider Identifier
1487295887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 13307
- Practice address
- 3 Northwestern Dr
Bloomfield, CT 06002-3465 - Phone
- (860) 263-0441
- NPI assigned
- Oct 7, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN1858500 | MA | |
| Dentist | 122300000X | 13307 | CT | Primary |
Addresses
Primary practice location
3 Northwestern Dr
Bloomfield, CT 06002-3465
Mailing address
14 Liberty SQ Apt 270
Bloomfield, CT 06002-5409
Phone (857) 800-4295
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13307 | CT | MD | Clinical Social Worker |
| DN1858500 | MA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674518400000",
"number": "1487295887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 LIBERTY SQ APT 270",
"city": "BLOOMFIELD",
"state": "CT",
"postal_code": "060025409",
"telephone_number": "857-800-4295"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 NORTHWESTERN DR",
"city": "BLOOMFIELD",
"state": "CT",
"postal_code": "060023465",
"telephone_number": "860-263-0441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JANGAM",
"first_name": "TEJASVINI GOUD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-07",
"last_updated": "2023-01-24",
"certification_date": "2023-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DN1858500",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CT",
"license": "13307",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomfield, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.