Individual provider Active NPI

Herman Deol, DDS

  • General Practice Dentistry
  • Kenton, OH
National Provider Identifier
1770152480
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30.027668 Issued in OH
Practice address
965 E Columbus St
Kenton, OH 43326-1650
Phone
(419) 675-2210
NPI assigned
Jun 18, 2021
Last updated
Nov 26, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 61880 KS
General Practice Dentistry 1223G0001X 30.027668 OH Primary

Addresses

Primary practice location

965 E Columbus St
Kenton, OH 43326-1650

Mailing address

965 E Columbus St
Kenton, OH 43326-1650
Phone (248) 657-0065

Other practice location 1

2306 1st Ave
Dodge City, KS 67801-2527
Phone (620) 225-5154 ext. 5154

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

State licenses

LicenseStateTypeSpecialty
61880KSMDDentist
30.027668OHMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Deol Dental Upper Arlington LLC Dentist Current Accepting new patients
Deol Dental Kenton LLC Dentist Current Accepting new patients
First Avenue Dental, P.a. General Practice CurrentSince Aug 28, 2021 Accepting new patients

Locations

2306 1st Ave
Dodge City, KS 67801
Phone (620) 225-5154

965 E Columbus St
Kenton, OH 43326
Phone (248) 657-0065

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1623974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732579200000",
    "number": "1770152480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 E COLUMBUS ST",
            "city": "KENTON",
            "state": "OH",
            "postal_code": "433261650",
            "telephone_number": "248-657-0065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 E COLUMBUS ST",
            "city": "KENTON",
            "state": "OH",
            "postal_code": "433261650",
            "telephone_number": "419-675-2210"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2306 1st Ave",
            "address_purpose": "LOCATION",
            "city": "Dodge City",
            "state": "KS",
            "postal_code": "678012527",
            "country_code": "US",
            "telephone_number": "620-225-5154 x5154",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEOL",
        "first_name": "HERMAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-18",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KS",
            "license": "61880",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.027668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; 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.