Active NPI
Eden Baluyote Vincent, DMD LLC
- General Practice Dentistry
- West Orange, NJ
National Provider Identifier
1063562783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DI17900
- Practice address
- 508 Pleasant Valley Way
West Orange, NJ 07052 - Phone
- (973) 731-0087
- Fax
- (973) 731-0024
- NPI assigned
- Jan 12, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DI17900 | NJ | Primary |
Addresses
Primary practice location
508 Pleasant Valley Way
West Orange, NJ 07052
Mailing address
508 Pleasant Valley Way
West Orange, NJ 07052
Phone (973) 731-0087
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DI17900 | NJ | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063562783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "508 PLEASANT VALLEY WAY",
"city": "WEST ORANGE",
"state": "NJ",
"postal_code": "07052",
"telephone_number": "973-731-0087",
"fax_number": "973-731-0024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "508 PLEASANT VALLEY WAY",
"city": "WEST ORANGE",
"state": "NJ",
"postal_code": "07052",
"telephone_number": "973-731-0087",
"fax_number": "973-731-0024"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VINCENT",
"first_name": "EDEN",
"middle_name": "BALUYOTE",
"credential": "DMD LLC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NJ",
"license": "DI17900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Orange, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.