NPIMap

Organization Active NPI

LTC Mobile Dental Services, P.a.

  • Dentist
  • Union, NJ
National Provider Identifier
1083936611
Registry record updated Sep 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
22DI01820201 Issued in NJ
Legal business name
LTC MOBILE DENTAL SERVICES, P.A.
Practice address
1961 Morris Ave
Suite a-7
Union, NJ 07083-3531
Phone
(551) 404-5769
Fax
(866) 810-8101
NPI assigned
Feb 23, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2011

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

Authorized official

Name
Dr. Rama E. Gvildys, DMDNPI 1427108307
Title
President
Phone
(551) 404-5769

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 22DI01820201 NJ Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 22DI02289100 NJ

Addresses

Primary practice location

1961 Morris Ave
Suite a-7
Union, NJ 07083-3531

Mailing address

1961 Morris Ave
Suite a-7
Union, NJ 07083-3531
Phone (551) 404-5769

Other identifiers 3

IdentifierTypeStateIssuer
1427108307MedicaidNJ
1700917127MedicaidNJ
1285785006MedicaidNJ

Other names 1

  • LTC MOBILE DENTAL SERVICES, P.A. Other name

National Provider Directory

National Provider Directory

Locations

1961 Morris Ave
Ste A7
Union, NJ 07083
Phone (551) 404-5769

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1266883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314835200000",
    "number": "1083936611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1961 MORRIS AVE",
            "address_2": "SUITE A-7",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070833531",
            "telephone_number": "551-404-5769",
            "fax_number": "866-810-8101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1961 MORRIS AVE",
            "address_2": "SUITE A-7",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070833531",
            "telephone_number": "551-404-5769",
            "fax_number": "866-810-8101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LTC MOBILE DENTAL SERVICES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-23",
        "last_updated": "2011-09-01",
        "status": "A",
        "authorized_official_last_name": "GVILDYS",
        "authorized_official_first_name": "RAMA",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "551-404-5769",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI01820201",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02289100",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1427108307",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700917127",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285785006",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LTC MOBILE DENTAL SERVICES, P.A.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Union, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.