Adisa Hamataj, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D010375 Issued in AZ

Practice address

9915 W McDowell Rd # Are106
Avondale, AZ 85392-4896

Phone

(623) 907-4562

NPI assigned

Jan 30, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gateway Dental Group, LLP

  • General Practice Dentistry
  • Avondale, AZ
  • NPI 1992834121
  NPD (past)
• Dental Professionals of Missouri, Richard Straus, D.M.D., P.C.

  • General Practice Dentistry
  • Saint Robert, MO
  • NPI 1164027306
  NPD (past)

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

{
    "created_epoch": "1454112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564444800000",
    "number": "1134587579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6975 E PRINCESS DR APT 3120",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850544234",
            "telephone_number": "917-664-5944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9915 W MCDOWELL RD # ARE106",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853924896",
            "telephone_number": "623-907-4562"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "316 Saint Robert Blvd",
            "address_purpose": "LOCATION",
            "city": "Saint Robert",
            "state": "MO",
            "postal_code": "655843363",
            "country_code": "US",
            "telephone_number": "573-336-2536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAMATAJ",
        "first_name": "ADISA",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-30",
        "last_updated": "2019-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2016013929",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D010375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Gwee
• Patricia Haberer, FNP
• Diane Hale
• Lisa R Hall, P.T.
• Loren Hall
• Melissa Marie Hamers, BCBA
• Mark Hamilton
• Casandra Ray Hamlin, AGNP-BC
• Susan Marie Hammerand, LBA
• Erin Hammit, LPC

• General Practice Dentistry in Avondale, AZ
• Providers in Avondale, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2019; 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.

Verify at the official NPI Registry.