Leonard Aaron Koltun, D.D.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D010172 Issued in AZ

Practice address

1425 S Greenfield Rd Ste 110
Mesa, AZ 85206-5505

Phone

(480) 854-3434

NPI assigned

Aug 19, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gila River Health Care Corporation

  dba Komatke Health Center

  • Critical Access Hospital
  • Laveen, AZ
  • NPI 1376538231

  TX

  Medicare reassignment NPD
• Gila River Health Care

  dba Thwajik Ke Outpatient Behavioral Health Services

  • Community/Behavioral Health Agency
  • Laveen, AZ
  • NPI 1598021495
  NPD
• Gila River Health Care Corporation

  dba AK-Chin Clinic

  • Rural Acute Care Hospital
  • Maricopa, AZ
  • NPI 1386633915
  NPD
• Gila River Health Care Corporation

  dba Red Tail Hawk Health Center

  • Critical Access Hospital
  • Chandler, AZ
  • NPI 1437664182
  NPD

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625529600000",
    "number": "1619969276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "761 E SNOWY FARM DR",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851407211",
            "telephone_number": "760-613-7991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 S GREENFIELD RD STE 110",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852065505",
            "telephone_number": "480-854-3434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLTUN",
        "first_name": "LEONARD",
        "middle_name": "AARON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "52806",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "AZ",
            "license": "D010172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Launa Faye Kolibas
• Arun K. Kolli, M.D.
• Saffron Kolodziej
• Swati Kolpuru, MD
• Kimberly Kolstad, LMSW
• Jacob Kolu, DMD
• Jeff Komar
• Lori Jo Kometer, MA, LIAC
• Morgan Kommer-Zahrbock
• Kevin Kon, PAC

• Periodontics in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Periodontics in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2021; 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.