Individual provider Active NPI

Jacob V Deno

  • Dentist
  • Norwalk, CT
National Provider Identifier
1659681765
Registry record updated Oct 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
10341 Issued in CT
Practice address
360 Connecticut Ave
Norwalk, CT 06854-1824
Phone
(203) 854-5458
NPI assigned
Oct 8, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 10341 CT Primary

Addresses

Primary practice location

360 Connecticut Ave
Norwalk, CT 06854-1824

Mailing address

PO Box 3189
Syracuse, NY 13220-3189

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.
Opted out of Medicare
Yes, effective Mar 24, 2016 through Mar 24, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
10341CTMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1286496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286496000000",
    "number": "1659681765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3189",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132203189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 CONNECTICUT AVE",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068541824",
            "telephone_number": "203-854-5458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENO",
        "first_name": "JACOB",
        "middle_name": "V",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-08",
        "last_updated": "2010-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "10341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwalk, CT

Sources for this page

Verify at the official NPI Registry.