Individual provider Active NPI

Katherine El Reda, DDS

  • Dentist
  • Sidney, OH
National Provider Identifier
1578322665
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
30.027606 Issued in OH
Practice address
2279 Michigan St
Sidney, OH 45365-9077
Phone
(937) 419-2034
NPI assigned
Mar 19, 2024
Last updated
Jun 5, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 30.027606 OH Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

2279 Michigan St
Sidney, OH 45365-9077

Mailing address

25710 Eton Ave
Dearborn Heights, MI 48125-1527
Phone (201) 713-8408

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

LicenseStateTypeSpecialty
30.027606OHMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1710806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1578322665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25710 ETON AVE",
            "city": "DEARBORN HEIGHTS",
            "state": "MI",
            "postal_code": "481251527",
            "telephone_number": "201-713-8408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2279 MICHIGAN ST",
            "city": "SIDNEY",
            "state": "OH",
            "postal_code": "453659077",
            "telephone_number": "937-419-2034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EL REDA",
        "first_name": "KATHERINE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-19",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.027606",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sidney, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; 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.