Molly Koochekpour, DDS

Key facts

NPI

1730701657

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

License

061758 (NY)

Practice address

277 W Main St
Victor, NY 14564-1123

Phone

(716) 380-7143

NPI assigned

May 13, 2020

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 1, 2021.

{
    "created_epoch": "1589328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627776000000",
    "number": "1730701657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1635 CRITTENDEN RD APT 5",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146232361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 W MAIN ST",
            "city": "VICTOR",
            "state": "NY",
            "postal_code": "145641123",
            "telephone_number": "716-380-7143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOOCHEKPOUR",
        "first_name": "MOLLY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-13",
        "last_updated": "2021-08-01",
        "certification_date": "2021-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "061758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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