Louis Vincent Theodos, DMD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

007113 Issued in CT

Practice address

52 Federal Rd Ste 2a
Danbury, CT 06810-6162

Phone

(203) 790-6288

NPI assigned

Aug 13, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401753600000",
    "number": "1982616074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 FEDERAL RD STE 2A",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068106162",
            "telephone_number": "203-790-6288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 FEDERAL RD STE 2A",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068106162",
            "telephone_number": "203-790-6288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEODOS",
        "first_name": "LOUIS",
        "middle_name": "VINCENT",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2014-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "CT",
            "license": "007113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral & Maxillofacial Surgery (D.M.D.) in Danbury, CT
• Providers in Danbury, CT by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2014; 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.