Dionysios John Tzoumas, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

061510 Issued in NY

Practice address

245 Range Rd
Southport, CT 06890-1085

Phone

(475) 216-9593

NPI assigned

Oct 5, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1633392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1831861004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 RANGE RD",
            "city": "SOUTHPORT",
            "state": "CT",
            "postal_code": "068901085",
            "telephone_number": "475-216-9593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 RANGE RD",
            "city": "SOUTHPORT",
            "state": "CT",
            "postal_code": "068901085",
            "telephone_number": "475-216-9593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TZOUMAS",
        "first_name": "DIONYSIOS",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-10-05",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "061510",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122300000X",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Fairfield",
            "affiliation": "N",
            "address_1": "245 Range Rd",
            "city": "Southport",
            "state": "CT",
            "country_code": "US",
            "postal_code": "068901085",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Fairfield",
            "affiliation": "N",
            "address_1": "245 Range Rd",
            "city": "Southport",
            "state": "CT",
            "country_code": "US",
            "postal_code": "068901085",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Dentist in Southport, CT
• Providers in Southport, CT by specialty
• Dentist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; 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.