Active NPI
John George Poulos, DDS
- Prosthodontics
- Northport, NY
National Provider Identifier
1871007773
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 31347
- Practice address
- 22 Laurel Ave
Northport, NY 11768-3165 - Phone
- (631) 262-0644
- Fax
- (631) 262-0645
- NPI assigned
- Nov 30, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 31347 | NY | Primary |
Addresses
Primary practice location
22 Laurel Ave
Northport, NY 11768-3165
Mailing address
22 Laurel Ave
Northport, NY 11768-3165
Phone (631) 262-0644
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
| License | State | Type | Specialty |
|---|---|---|---|
| 31347 | NY | MD | Prosthodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| John G Poulos DDS | Prosthodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Prosthodontics
- Northport, NY
- NPI 1932597606
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512000000000",
"number": "1871007773",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 LAUREL AVE",
"city": "NORTHPORT",
"state": "NY",
"postal_code": "117683165",
"telephone_number": "631-262-0644",
"fax_number": "631-262-0645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 LAUREL AVE",
"city": "NORTHPORT",
"state": "NY",
"postal_code": "117683165",
"telephone_number": "631-262-0644",
"fax_number": "631-262-0645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POULOS",
"first_name": "JOHN",
"middle_name": "GEORGE",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-11-30",
"last_updated": "2017-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "NY",
"license": "31347",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.