Peter Gletzakos, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

8252 Issued in CT

Practice address

595 Main Street
Portland, CT 06480-1156

Phone

(860) 342-4502

Fax

(860) 342-5474

NPI assigned

Aug 29, 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 CT

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

State licenses

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.

• Portland Dental Care LLC

  • Dentist
  • Portland, CT
  • NPI 1174605562
  Authorized official Same address or phone

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669581369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 MAIN STREET",
            "city": "PORTLAND",
            "state": "CT",
            "postal_code": "064801156",
            "telephone_number": "860-342-4502",
            "fax_number": "860-342-5474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 MAIN STREET",
            "city": "PORTLAND",
            "state": "CT",
            "postal_code": "064801156",
            "telephone_number": "860-342-4502",
            "fax_number": "860-342-5474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLETZAKOS",
        "first_name": "PETER",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "8252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dr. John L. Mormile Chiropractor LLC
• Julie S. Dudek, LPC
• Melissa A Fazzolari, APRN
• Morgan Bryant Feshler
• Yiannis Zannis Gazis, DDS
• Donna S. Grisham, LADC
• Wendy Griswold, APRN
• Susan Mary Gubilee, MS, MSW
• Linda Pantano Hassett, OTR/L
• Deborah B. Heilman, MSPT

• Dentist in Portland, CT
• Providers in Portland, CT by specialty
• Dentist in Connecticut

• 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.