Individual provider Active NPI

Monika Magdalena Kudla, DDS

  • Dentist
  • Jamestown, NY
National Provider Identifier
1700913019
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
051501-01 Issued in NY
Practice address
107 Institute St
Jamestown, NY 14701-6628
Phone
(716) 484-4334
NPI assigned
Feb 27, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 051501-01 NY Primary

Addresses

Primary practice location

107 Institute St
Jamestown, NY 14701-6628

Mailing address

107 Institute St
Jamestown, NY 14701-6628
Phone (716) 484-4334

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20230809002264 NY Practitioner - Dentist 7113389024 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
051501-01NYMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
The Chautauqua Center, Inc CurrentSince Jun 27, 2023 Accepting new patients

Locations

1134 Central Ave
Dunkirk, NY 14048
Phone (716) 366-6036

107 Institute St
Jamestown, NY 14701
Phone (716) 484-4334

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1700913019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 INSTITUTE ST",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147016628",
            "telephone_number": "716-484-4334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 INSTITUTE ST",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147016628",
            "telephone_number": "716-484-4334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUDLA",
        "first_name": "MONIKA",
        "middle_name": "MAGDALENA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-27",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "051501-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamestown, NY

Sources for this page

Verify at the official NPI Registry.