Active NPI
Stella Koletic, DDS
- Dentist
- Encino, CA
National Provider Identifier
1730358409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 34135
- Practice address
- 5400 Balboa Blvd
Suite 303
Encino, CA 91316-1502 - Phone
- (818) 789-6257
- Fax
- (818) 789-0415
- NPI assigned
- Feb 26, 2008
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 34135 | CA | Primary |
Addresses
Primary practice location
5400 Balboa Blvd
Suite 303
Encino, CA 91316-1502
Mailing address
5400 Balboa Blvd
Suite 303
Encino, CA 91316-1502
Phone (818) 789-6257
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 512137 | Other | CA | DENTICAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203984000000",
"number": "1730358409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5400 BALBOA BLVD",
"address_2": "SUITE 303",
"city": "ENCINO",
"state": "CA",
"postal_code": "913161502",
"telephone_number": "818-789-6257",
"fax_number": "818-789-0415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5400 BALBOA BLVD",
"address_2": "SUITE 303",
"city": "ENCINO",
"state": "CA",
"postal_code": "913161502",
"telephone_number": "818-789-6257",
"fax_number": "818-789-0415"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLETIC",
"first_name": "STELLA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-26",
"last_updated": "2008-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "34135",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTICAL",
"identifier": "512137",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Encino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.