Active NPI
Mouni Damineni
- General Practice Dentistry
- Neosho, MO
National Provider Identifier
1962074104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2021018763
- Practice address
- 2040 Laquesta Dr
Neosho, MO 64850 - Phone
- (417) 451-1566
- NPI assigned
- Jul 16, 2021
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2021018763 | MO | Primary |
Addresses
Primary practice location
2040 Laquesta Dr
Neosho, MO 64850
Mailing address
847 Little Bear Loop
Lewis Center, OH 43035-9729
Phone (614) 886-6865
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 |
|---|---|---|---|
| 2021018763 | MO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626393600000",
"number": "1962074104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "847 LITTLE BEAR LOOP",
"city": "LEWIS CENTER",
"state": "OH",
"postal_code": "430359729",
"telephone_number": "614-886-6865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2040 LAQUESTA DR",
"city": "NEOSHO",
"state": "MO",
"postal_code": "64850",
"telephone_number": "417-451-1566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAMINENI",
"first_name": "MOUNI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-16",
"last_updated": "2021-07-16",
"certification_date": "2021-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MO",
"license": "2021018763",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Neosho, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.