Active NPI
Douglas J Macko, DMD
- Pediatric Dentistry
- Southington, CT
National Provider Identifier
1881744092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 004917
- Practice address
- 55 Meriden Avenue
Suite 3F
Southington, CT 06489 - Phone
- (860) 621-8959
- Fax
- (860) 628-2459
- NPI assigned
- Jan 11, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 004917 | CT | Primary |
Addresses
Primary practice location
55 Meriden Avenue
Suite 3F
Southington, CT 06489
Mailing address
55 Meriden Avenue
Suite 3F
Southington, CT 06489
Phone (860) 621-8959
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881744092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 MERIDEN AVENUE",
"address_2": "SUITE 3F",
"city": "SOUTHINGTON",
"state": "CT",
"postal_code": "06489",
"telephone_number": "860-621-8959",
"fax_number": "860-628-2459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 MERIDEN AVENUE",
"address_2": "SUITE 3F",
"city": "SOUTHINGTON",
"state": "CT",
"postal_code": "06489",
"telephone_number": "860-621-8959",
"fax_number": "860-628-2459"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACKO",
"first_name": "DOUGLAS",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CT",
"license": "004917",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southington, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.