Theodore Nicholas Kondos, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

4254 Issued in OK

Practice address

2208 N Broadway #104
Poteau, OK 74953-0933

Phone

(918) 647-8266

Fax

(918) 647-9118

NPI assigned

Nov 16, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

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

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.

• Dr Theodore W Kondos DDS PC

  • Dentist
  • Poteau, OK
  • NPI 1457518060
  Authorized official Same address or phone

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659444602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 933",
            "address_2": "2208 N BROADWAY #104",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749530933",
            "telephone_number": "918-647-8266",
            "fax_number": "918-647-9118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2208 N BROADWAY #104",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749530933",
            "telephone_number": "918-647-8266",
            "fax_number": "918-647-9118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONDOS",
        "first_name": "THEODORE",
        "middle_name": "NICHOLAS",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OK",
            "license": "4254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Poteau, OK
• Providers in Poteau, OK by specialty
• Dentist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.