NPIMap

Organization Active NPI

Family Dental Associates

  • General Practice Dentistry
  • Rutland, VT
National Provider Identifier
1487853644
Registry record updated Jul 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
769 Issued in VT
Legal business name
FAMILY DENTAL ASSOCIATES
Practice address
4 General Wing Rd
Rutland, VT 05701-4682
Phone
(802) 775-0819
Fax
(802) 775-1487
NPI assigned
Jul 17, 2007
Last updated
Jul 17, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2007

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

Authorized official

Name
Dr. Robert Stephen Kolodzej, DMDNPI 1881629632
Title
Senior Partner
Phone
(802) 775-0819

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 871 VT
General Practice Dentistry 1223G0001X 1112 VT
General Practice Dentistry 1223G0001X 769 VT Primary

Addresses

Primary practice location

4 General Wing Rd
Rutland, VT 05701-4682

Mailing address

4 General Wing Rd
Rutland, VT 05701-4682
Phone (802) 775-0819

Other identifiers 2

IdentifierTypeStateIssuer
1000430MedicaidVT
FAMI2398OtherVTBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1184630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184630400000",
    "number": "1487853644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 GENERAL WING RD",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014682",
            "telephone_number": "802-775-0819",
            "fax_number": "802-775-1487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 GENERAL WING RD",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014682",
            "telephone_number": "802-775-0819",
            "fax_number": "802-775-1487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-17",
        "last_updated": "2007-07-17",
        "status": "A",
        "authorized_official_last_name": "KOLODZEJ",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "STEPHEN",
        "authorized_official_title_or_position": "SENIOR PARTNER",
        "authorized_official_telephone_number": "802-775-0819",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VT",
            "license": "871",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VT",
            "license": "1112",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VT",
            "license": "769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000430",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "FAMI2398",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rutland, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; 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.