Active NPI
Justine Tanjaya, DDS, MS, PHD
- Orthodontics and Dentofacial Orthopedics Dentistry
- Arlington, TX
National Provider Identifier
1013560598
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 35540
- Practice address
- 1604 New York Ave
Arlington, TX 76010-4724 - Phone
- (619) 549-6520
- NPI assigned
- Jul 23, 2019
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 35540 | TX | Primary |
Addresses
Primary practice location
1604 New York Ave
Arlington, TX 76010-4724
Mailing address
3790 Cedarplaza LN Apt 2324
Dallas, TX 75209-6379
Phone (619) 549-6520
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
- Credentials
- Master of Science, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35540 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563840000000",
"number": "1013560598",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3790 CEDARPLAZA LN APT 2324",
"city": "DALLAS",
"state": "TX",
"postal_code": "752096379",
"telephone_number": "619-549-6520"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1604 NEW YORK AVE",
"city": "ARLINGTON",
"state": "TX",
"postal_code": "760104724",
"telephone_number": "619-549-6520"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANJAYA",
"first_name": "JUSTINE",
"credential": "DDS, MS, PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-23",
"last_updated": "2019-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "TX",
"license": "35540",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arlington, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.