Individual provider Active NPI

Venkata Velagapudi

  • General Practice Dentistry
  • Enfield, CT
National Provider Identifier
1538539960
Registry record updated Apr 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
011512 Issued in CT
Practice address
54 Hazard Ave
Dr .Dental
Enfield, CT 06082-3845
Phone
(972) 974-9926
Fax
(860) 745-8804
NPI assigned
Sep 28, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 011512 CT Primary

Addresses

Primary practice location

54 Hazard Ave
Dr .Dental
Enfield, CT 06082-3845

Mailing address

155 Windermere Ave
Unit # 3005
Ellington, CT 06029-5800
Phone (972) 974-9926

Other identifiers 1

IdentifierTypeStateIssuer
011512OtherCTCONNECTICUT DEPARTMENT OF PUBLIC HEALTH ( DENTAL LICENCE)

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160325000319 CT Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 9931406527

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
011512CTMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1443398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461801600000",
    "number": "1538539960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 WINDERMERE AVE",
            "address_2": "UNIT # 3005",
            "city": "ELLINGTON",
            "state": "CT",
            "postal_code": "060295800",
            "telephone_number": "972-974-9926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 HAZARD AVE",
            "address_2": "DR .DENTAL",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060823845",
            "telephone_number": "972-974-9926",
            "fax_number": "860-745-8804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VELAGAPUDI",
        "first_name": "VENKATA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-28",
        "last_updated": "2016-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "011512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICUT DEPARTMENT OF PUBLIC HEALTH ( DENTAL LICENCE)",
            "identifier": "011512",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Enfield, CT

Sources for this page

Verify at the official NPI Registry.