Individual provider Active NPI

Kevin Kalusha, D.D.S.

  • General Practice Dentistry
  • Fort Worth, TX
National Provider Identifier
1821149022
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
18903 Issued in TX
Practice address
2101 Handley Dr
Suite 5
Fort Worth, TX 76112-5100
Phone
(817) 451-4041
NPI assigned
Jan 15, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 18903 TX Primary

Addresses

Primary practice location

2101 Handley Dr
Suite 5
Fort Worth, TX 76112-5100

Mailing address

2101 Handley Dr
Suite 5
Fort Worth, TX 76112-5100
Phone (817) 451-4041

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20150414001022 TX Order and Referring Only - DentistPractitioner - Dentist 1052639580

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18903TXMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821149022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 HANDLEY DR",
            "address_2": "SUITE 5",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761125100",
            "telephone_number": "817-451-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 HANDLEY DR",
            "address_2": "SUITE 5",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761125100",
            "telephone_number": "817-451-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALUSHA",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "18903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.