Marina Kristin Kanakos

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

22DI02961600 Issued in NJ

Practice address

4 Burton LN Ste 400
Mullica Hill, NJ 08062-9441

Phone

(856) 842-5400

NPI assigned

Mar 18, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CT

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Pediatric Dentistry of Mullica Hill, Limited Liability Company

  • Pediatric Dentistry
  • Mullica Hill, NJ
  • NPI 1992189179
  NPD (past)

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

{
    "created_epoch": "1616025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1962088278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 BURTON LN STE 400",
            "city": "MULLICA HILL",
            "state": "NJ",
            "postal_code": "080629441",
            "telephone_number": "856-842-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 BURTON LN STE 400",
            "city": "MULLICA HILL",
            "state": "NJ",
            "postal_code": "080629441",
            "telephone_number": "856-842-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANAKOS",
        "first_name": "MARINA",
        "middle_name": "KRISTIN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-18",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": "13099",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "22DI02961600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkanakos45632@direct.med.uchc.edu",
            "affiliation": "N",
            "address_1": "263 Farmington Ave",
            "city": "Farmington",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060300001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kevin Johnsen, DO
• Dominique Johnson, PT
• Jennifer Ann Jones, MA CCCSLP
• Venkatasai Jonna
• Harthik Kambhampati
• Karen Weiliang Kang, PHARMD
• Kaplan & Tyson, LLC Dba Eye Associates
• Moli Karsalia, MD
• Adam Katzenberg, DO
• Kurt W Kaulback, MD

• Pediatric Dentistry in Mullica Hill, NJ
• Providers in Mullica Hill, NJ by specialty
• Pediatric Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.