NPIMap

Individual provider Active NPI

Gibson Bartelus, D.D.S.

  • General Practice Dentistry
  • Lanham, MD
National Provider Identifier
1114448826
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
17357 Issued in MD
Practice address
2830 Campus Way N Ste 614
Lanham, MD 20706-1669
Phone
(301) 955-9198
NPI assigned
Jul 3, 2017
Last updated
Jun 18, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN1858161 MA
General Practice Dentistry 1223G0001X 17357 MD Primary

Addresses

Primary practice location

2830 Campus Way N Ste 614
Lanham, MD 20706-1669

Mailing address

7730 Harkins Rd Apt 471
Lanham, MD 20706-1365
Phone (617) 633-4312

Other practice location 1

1775 Grand Concourse
6th Floor
Bronx, NY 10453
Phone (718) 901-8110

Other practice location 2

270 New State Hwy Ste 9A
Raynham, MA 02767-5459
Phone (508) 822-1100

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

LicenseStateTypeSpecialty
DN1858161MAMDDentist
17357MDMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater LLC Dentist PastSince Jun 23, 2024 Accepting new patients
Dental Dreams LLC General Practice Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1499040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718668800000",
    "number": "1114448826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7730 HARKINS RD APT 471",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207061365",
            "telephone_number": "617-633-4312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2830 CAMPUS WAY N STE 614",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207061669",
            "telephone_number": "301-955-9198"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1775 Grand Concourse",
            "address_2": "6th Floor",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "10453",
            "country_code": "US",
            "telephone_number": "718-901-8110",
            "fax_number": "718-901-8162",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "270 New State Hwy Ste 9A",
            "address_purpose": "LOCATION",
            "city": "Raynham",
            "state": "MA",
            "postal_code": "027675459",
            "country_code": "US",
            "telephone_number": "508-822-1100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BARTELUS",
        "first_name": "GIBSON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-03",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1858161",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "17357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lanham, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; 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.