Active NPI
Bijan Reza Ahmadzadeh, D.M.D.
- Dentist
- Lake Ariel, PA
National Provider Identifier
1063726255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS038398
- Practice address
- 358 Hamlin Hwy
Suite 2
Lake Ariel, PA 18436-0000 - Phone
- (570) 689-2449
- Fax
- (866) 658-1522
- NPI assigned
- Jul 30, 2010
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DS038398 | PA | Primary |
Addresses
Primary practice location
358 Hamlin Hwy
Suite 2
Lake Ariel, PA 18436-0000
Mailing address
358 Hamlin Hwy
Suite 2
Lake Ariel, PA 18436-0000
Phone (570) 689-2449
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS038398 | PA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ariel Dental LLC | Dentist | Current | Accepting new patients |
Locations
358 Hamlin Hwy
#2
Lake Ariel, PA 18436
Phone (570) 689-2449
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Lake Ariel, PA
- NPI 1669502159
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597708800000",
"number": "1063726255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "358 HAMLIN HWY",
"address_2": "SUITE 2",
"city": "LAKE ARIEL",
"state": "PA",
"postal_code": "184360000",
"telephone_number": "570-689-2449",
"fax_number": "866-658-1522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "358 HAMLIN HWY",
"address_2": "SUITE 2",
"city": "LAKE ARIEL",
"state": "PA",
"postal_code": "184360000",
"telephone_number": "570-689-2449",
"fax_number": "866-658-1522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AHMADZADEH",
"first_name": "BIJAN",
"middle_name": "REZA",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-07-30",
"last_updated": "2020-08-18",
"certification_date": "2020-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS038398",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Ariel, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.