Active NPI
Ali Khayyer, DDS
- General Practice Dentistry
- Middletown, CT
National Provider Identifier
1508247214
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 11686
- Practice address
- 675 Main Street
Middletown, CT 06457 - Phone
- (860) 347-6971
- NPI assigned
- Jun 18, 2015
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 11686 | CT | Primary |
Addresses
Primary practice location
675 Main Street
Middletown, CT 06457
Mailing address
111 Aspen Glen Dr
Hamden, CT 06518-3786
Phone (703) 300-6503
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004011136 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160917000302 | CT | Order and Referring Only - Dentist | 8224325360 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485388800000",
"number": "1508247214",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 ASPEN GLEN DR",
"city": "HAMDEN",
"state": "CT",
"postal_code": "065183786",
"telephone_number": "703-300-6503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "675 MAIN STREET",
"city": "MIDDLETOWN",
"state": "CT",
"postal_code": "06457",
"telephone_number": "860-347-6971"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAYYER",
"first_name": "ALI",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-06-18",
"last_updated": "2017-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CT",
"license": "11686",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004011136",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Middletown, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.