Jacob Marshall Gady, D.M.D., M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

011331 Issued in CT

Practice address

80 S Main St
West Hartford, CT 06107-2408

Phone

(860) 231-1030

Fax

(860) 231-1032

NPI assigned

Jun 19, 2009

Last updated

Oct 17, 2022By the provider in NPPES

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Previously, effective Oct 1, 2020 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Connecticut Center for Oral Facial and Implant Surgery PC

  • Oral and Maxillofacial Surgery Clinic/Center
  • West Hartford, CT
  • NPI 1053782060
  Authorized official Same address or phone

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

{
    "created_epoch": "1245369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665964800000",
    "number": "1023245842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 S MAIN ST",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072408",
            "telephone_number": "860-231-1030",
            "fax_number": "860-231-1032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 S MAIN ST",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072408",
            "telephone_number": "860-231-1030",
            "fax_number": "860-231-1032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GADY",
        "first_name": "JACOB",
        "middle_name": "MARSHALL",
        "name_prefix": "Dr.",
        "credential": "D.M.D., M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-19",
        "last_updated": "2022-10-17",
        "certification_date": "2022-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "011331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Newman Fromson, M.D.
• Yolanda P Frontera, DDS, MDS
• Michael Nicholas Fulco, PHD
• Full Stack Psychology
• Kirsten Gaddis, OTR/L
• Kaitlyn A. Gagne, M.A., CCC-SLP
• Gail Corneau, PHD, PLLC
• Michael Moses Gale, PH.D.
• Rafael Gallegos, PSYD
• Anne Marie Marie Galli

• Dentist in West Hartford, CT
• Providers in West Hartford, CT by specialty
• Dentist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2022; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.