NPIMap

Organization Active NPI

Dr. Altman and Dr. Kwon Dental Group

  • Dentist
  • East Hartford, CT
National Provider Identifier
1760716401
Registry record updated Sep 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
4715 Issued in CT
Legal business name
DR. ALTMAN AND DR. KWON DENTAL GROUP
Practice address
1011 Main St
East Hartford, CT 06108-2294
Phone
(860) 528-3350
Fax
(860) 289-6875
NPI assigned
Sep 29, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2009

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

Authorized official

Name
Dr. Jeffrey Altman, DDS
Title
Dentist
Phone
(860) 528-3350

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 4715 CT Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 10110 CT
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 10004 CT

Addresses

Primary practice location

1011 Main St
East Hartford, CT 06108-2294

Mailing address

1011 Main St
East Hartford, CT 06108
Phone (860) 528-3350

Other identifiers 3

IdentifierTypeStateIssuer
1053481267MedicaidCT
1770759961MedicaidCT
1093048290MedicaidCT

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1254182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254182400000",
    "number": "1760716401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 MAIN ST",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "06108",
            "telephone_number": "860-528-3350",
            "fax_number": "860-289-6875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 MAIN ST",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061082294",
            "telephone_number": "860-528-3350",
            "fax_number": "860-289-6875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. ALTMAN AND DR. KWON DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-29",
        "last_updated": "2009-09-29",
        "status": "A",
        "authorized_official_last_name": "ALTMAN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "860-528-3350",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CT",
            "license": "4715",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CT",
            "license": "10110",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CT",
            "license": "10004",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053481267",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1770759961",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093048290",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Hartford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.