Susmitha Rao Koti, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D11308 Issued in OR

Practice address

1740 W 17TH Ave
Eugene, OR 97402-3619

Phone

(458) 210-3543

NPI assigned

Aug 16, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1281916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598486400000",
    "number": "1578878435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 NORTHCHASE PKWY SE",
            "address_2": "SUITE 290",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300676405",
            "telephone_number": "678-904-5665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 W 17TH AVE",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974023619",
            "telephone_number": "458-210-3543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTI",
        "first_name": "SUSMITHA RAO",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-16",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "27635",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN014164",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OR",
            "license": "D11308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Koru Health Center, LLC
• Koru LLC
• Arianna Kosel, PCA
• Titus Barngetuny Kosgei, CNP
• Brenda Kosydar
• Jeremy Kotin
• Lisa Marie Kovacevic, RN, FNP
• Zita Kovacs
• Katie L Kowalski, PT
• Cindi Koyama

• Pediatric Dentistry in Eugene, OR
• Providers in Eugene, OR by specialty
• Pediatric Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2020; 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.

Verify at the official NPI Registry.