Active NPI
Balaram Kolasani
- Dentist
- Las Cruces, NM
National Provider Identifier
1649907601
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6001150-15
- Practice address
- 1160 El Paseo Rd
Las Cruces, NM 88001-6045 - Phone
- (575) 652-3084
- NPI assigned
- Aug 1, 2022
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DD5648 | NM | |
| Dentist | 122300000X | 6001150-15 | WI | Primary |
Addresses
Primary practice location
1160 El Paseo Rd
Las Cruces, NM 88001-6045
Mailing address
2225 Bex St Apt L
Las Cruces, NM 88005-3375
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 |
|---|---|---|---|
| 6001150-15 | WI | MD | Dentist |
| DD5648 | NM | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1659312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681948800000",
"number": "1649907601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2225 BEX ST APT L",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880053375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1160 EL PASEO RD",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880016045",
"telephone_number": "575-652-3084"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLASANI",
"first_name": "BALARAM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-08-01",
"last_updated": "2023-04-20",
"certification_date": "2023-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NM",
"license": "DD5648",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "6001150-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Cruces, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.