Active NPI
Thomas Christian Kiebach, D.D.S.
- Dentist
- Glastonbury, CT
National Provider Identifier
1649605957
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2.011047
- Practice address
- 3043 Main St
Putnam Bridge Plaza (Suite a)
Glastonbury, CT 06033-1029 - Phone
- (860) 657-9212
- NPI assigned
- Sep 5, 2013
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 2.011047 | CT | Primary |
Addresses
Primary practice location
3043 Main St
Putnam Bridge Plaza (Suite a)
Glastonbury, CT 06033-1029
Mailing address
1170 Boulevard
West Hartford, CT 06119-1721
Phone (225) 281-7985
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 |
|---|---|---|---|
| 2.011047 | CT | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378339200000",
"number": "1649605957",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1170 BOULEVARD",
"city": "WEST HARTFORD",
"state": "CT",
"postal_code": "061191721",
"telephone_number": "225-281-7985"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3043 MAIN ST",
"address_2": "PUTNAM BRIDGE PLAZA (SUITE A)",
"city": "GLASTONBURY",
"state": "CT",
"postal_code": "060331029",
"telephone_number": "860-657-9212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIEBACH",
"first_name": "THOMAS",
"middle_name": "CHRISTIAN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-09-05",
"last_updated": "2013-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CT",
"license": "2.011047",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glastonbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.