Active NPI
Eliane Hermes Dutra, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Farmington, CT
National Provider Identifier
1659711620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 11733
- Practice address
- 263 Farmington Ave
Farmington, CT 06030-0001 - Phone
- (860) 679-2207
- Fax
- (860) 679-1899
- NPI assigned
- Jul 4, 2013
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 11733 | CT | Primary |
Addresses
Primary practice location
263 Farmington Ave
Farmington, CT 06030-0001
Mailing address
100 Trumbull St Apt 301
Hartford, CT 06103-2430
Phone (914) 255-0258
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160412001571 | CT | Order and Referring Only - Other (Physician) | 3870891690 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11733 | CT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477440000000",
"number": "1659711620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 TRUMBULL ST APT 301",
"city": "HARTFORD",
"state": "CT",
"postal_code": "061032430",
"telephone_number": "914-255-0258"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "263 FARMINGTON AVE",
"city": "FARMINGTON",
"state": "CT",
"postal_code": "060300001",
"telephone_number": "860-679-2207",
"fax_number": "860-679-1899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUTRA",
"first_name": "ELIANE",
"middle_name": "HERMES",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-07-04",
"last_updated": "2016-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "CT",
"license": "11733",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Farmington, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2016; 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.