Odai Abushanab, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

22DI02760901 Issued in NJ

Practice address

110 Bergen St
Newark, NJ 07103-2495

Phone

(973) 972-3126

NPI assigned

Apr 11, 2018

Last updated

Jun 4, 2024By the provider in NPPES

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 NJ

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

Locations

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.

• Rutgers Health -University Dental Associates

  • Endodontics
  • Newark, NJ
  • NPI 1346454584

  Oral and Maxillofacial Surgery

  Medicare reassignment NPD
• Rutgers Health Dental Associates Os-NWK

  • Oral and Maxillofacial Surgery (Dentist)
  • Newark, NJ
  • NPI 1023766086
  NPD

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

{
    "created_epoch": "1523404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1053818302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82 SMITHTOWN RD",
            "city": "BUDD LAKE",
            "state": "NJ",
            "postal_code": "078281932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BERGEN ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071032495",
            "telephone_number": "973-972-3126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABUSHANAB",
        "first_name": "ODAI",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-11",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "22DI02760901",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yazeed Fawwaz Abu Ruman, M.B.B.S
• Ahmed Abu Taleb, M.D
• Nancy Leroux Abud, M.D.
• Abundant Hope Developmental Supports NJ LLC
• Mohammad Abushanab, MD
• Islam K Abusido, M.D.
• Access Medicine NJ
• Luis Acevedo
• Sashali Acevedo
• Pankaja Achar, MD

• Oral and Maxillofacial Surgery (Dentist) in Newark, NJ
• Providers in Newark, NJ by specialty
• Oral and Maxillofacial Surgery (Dentist) in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; 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.