Active NPI
Joseph C Ardizzone, DDS
- Dentist
- Federal Way, WA
National Provider Identifier
1134458367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6193
- Practice address
- 30317 16TH Ave S
Federal Way, WA 98003-4124 - Phone
- (253) 839-7270
- Fax
- (253) 941-1336
- NPI assigned
- Dec 17, 2009
- Last updated
- Dec 17, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 | 6193 | WA | Primary |
Addresses
Primary practice location
30317 16TH Ave S
Federal Way, WA 98003-4124
Mailing address
30317 16TH Ave S
Federal Way, WA 98003-4124
Phone (253) 839-7270
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 91-1594091 | Other | WA | TAX ID # |
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 |
|---|---|---|---|
| 6193 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1261008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1261008000000",
"number": "1134458367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30317 16TH AVE S",
"city": "FEDERAL WAY",
"state": "WA",
"postal_code": "980034124",
"telephone_number": "253-839-7270",
"fax_number": "253-941-1336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30317 16TH AVE S",
"city": "FEDERAL WAY",
"state": "WA",
"postal_code": "980034124",
"telephone_number": "253-839-7270",
"fax_number": "253-941-1336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ARDIZZONE",
"first_name": "JOSEPH",
"middle_name": "C",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-12-17",
"last_updated": "2009-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "6193",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID #",
"identifier": "91-1594091",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Federal Way, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.