Jordan Ghiassi, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DD4342 Issued in NM

Practice address

2100 Calle de la Vuelta Unit E101
Santa Fe, NM 87505-4819

Phone

(505) 988-5752

NPI assigned

Jul 17, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

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.

• Uptown Park Dental Practice, LLC

  • Dental Clinic/Center
  • Albuquerque, NM
  • NPI 1447427513
  NPD (past)

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

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610323200000",
    "number": "1053795112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 CALLE DE LA VUELTA UNIT E101",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875054819",
            "telephone_number": "505-988-5752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 CALLE DE LA VUELTA UNIT E101",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875054819",
            "telephone_number": "505-988-5752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHIASSI",
        "first_name": "JORDAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-17",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD4342",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NM",
            "license": "DD4342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Gerson
• Antonio Samuel Gervais, CRNA, RN
• Get Well on the Way
• Barbara M Getz, PT
• Jasmine S Ghee, FNP
• Bonnie J Giacchetti, PAC
• Sheila O'Shea Gibbens, PA-C
• Nora Gibbons, MD
• Kimberly Gibbs, LMT, RMTI
• Marianne Gibbs, RD

• Periodontics in Santa Fe, NM
• Providers in Santa Fe, NM by specialty
• Periodontics in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; 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.