NPIMap

Organization Active NPI

Nutmeg Orthodontics, LLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Windsor, CT
National Provider Identifier
1598433971
Registry record updated Sep 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
NUTMEG ORTHODONTICS, LLC
Practice address
62 Bloomfield Ave
Windsor, CT 06095-2808
Phone
(860) 688-6030
NPI assigned
Sep 1, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2021

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

Authorized official

Name
Dr. Anu Nellissery, DMD, MSNPI 1962895706
Title
Member
Phone
(860) 688-6030

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X Primary

Addresses

Primary practice location

62 Bloomfield Ave
Windsor, CT 06095-2808

Mailing address

62 Bloomfield Ave
Windsor, CT 06095-2808
Phone (860) 688-6030

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL www.drgange.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1630454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630454400000",
    "number": "1598433971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 BLOOMFIELD AVE",
            "city": "WINDSOR",
            "state": "CT",
            "postal_code": "060952808",
            "telephone_number": "860-688-6030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 BLOOMFIELD AVE",
            "city": "WINDSOR",
            "state": "CT",
            "postal_code": "060952808",
            "telephone_number": "860-688-6030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUTMEG ORTHODONTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-01",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A",
        "authorized_official_last_name": "NELLISSERY",
        "authorized_official_first_name": "ANU",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "860-688-6030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.drgange.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "62 Bloomfield Ave",
            "city": "Windsor",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060952808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Windsor, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; 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.