Active NPI
Mena Johny
- General Practice Dentistry
- Dayville, CT
National Provider Identifier
1598248668
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12364
- Practice address
- 24 Putnam Pike
Dayville, CT 06241-1646 - Phone
- (860) 779-6301
- NPI assigned
- Sep 13, 2018
- 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 | 12364 | CT | Primary |
Addresses
Primary practice location
24 Putnam Pike
Dayville, CT 06241-1646
Mailing address
1783 Mission Bay Cir Apt P-306
Rockledge, FL 32955-6685
Phone (321) 537-2810
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 |
|---|---|---|---|
| 12364 | CT | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536796800000",
"number": "1598248668",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1783 MISSION BAY CIR APT P-306",
"city": "ROCKLEDGE",
"state": "FL",
"postal_code": "329556685",
"telephone_number": "321-537-2810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 PUTNAM PIKE",
"city": "DAYVILLE",
"state": "CT",
"postal_code": "062411646",
"telephone_number": "860-779-6301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNY",
"first_name": "MENA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-09-13",
"last_updated": "2018-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CT",
"license": "12364",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dayville, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.