Active NPI
Jason Edmund Coliadis, D.D.S.
- Dentist
- Dayton, OH
National Provider Identifier
1508026824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2717
- Practice address
- 1 Wyoming St
Dayton, OH 45409-2722 - Phone
- (937) 208-3844
- Fax
- (937) 208-5393
- NPI assigned
- Jun 10, 2008
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 2717 | OH | Primary |
Addresses
Primary practice location
1 Wyoming St
Dayton, OH 45409-2722
Mailing address
1187 Steinbeck Way
Apt B
Fairborn, OH 45324-8738
Phone (614) 307-4092
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 |
|---|---|---|---|
| 2717 | OH | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213056000000",
"number": "1508026824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1187 STEINBECK WAY",
"address_2": "APT B",
"city": "FAIRBORN",
"state": "OH",
"postal_code": "453248738",
"telephone_number": "614-307-4092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 WYOMING ST",
"city": "DAYTON",
"state": "OH",
"postal_code": "454092722",
"telephone_number": "937-208-3844",
"fax_number": "937-208-5393"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLIADIS",
"first_name": "JASON",
"middle_name": "EDMUND",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-10",
"last_updated": "2008-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "2717",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 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.