Active NPI
Jon Andrew Kulesa, DDS
- Dentist
- Reno, NV
National Provider Identifier
1972657070
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4840T
- Practice address
- 315 W Peckham LN
Reno, NV 89509-5402 - Phone
- (775) 826-7600
- Fax
- (775) 826-5608
- NPI assigned
- Jan 23, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 4840T | NV | Primary |
Addresses
Primary practice location
315 W Peckham LN
Reno, NV 89509-5402
Mailing address
315 W Peckham LN
Reno, NV 89509-5402
Phone (775) 826-7600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160120002389 | NV | Order and Referring Only - Oral Surgery | 6002119328 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4840T | NV | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269820800000",
"number": "1972657070",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "315 W PECKHAM LN",
"city": "RENO",
"state": "NV",
"postal_code": "895095402",
"telephone_number": "775-826-7600",
"fax_number": "775-826-5608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "315 W PECKHAM LN",
"city": "RENO",
"state": "NV",
"postal_code": "895095402",
"telephone_number": "775-826-7600",
"fax_number": "775-826-5608"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KULESA",
"first_name": "JON",
"middle_name": "ANDREW",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-23",
"last_updated": "2010-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NV",
"license": "4840T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Reno, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2010; 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.