Bilal Damlaj, DMD, CAGS, MSD
Individual provider Active NPI Endodontics · Cicero, NY
NPI 1154701209 · NPPES record last updated Aug 27, 2020
Key facts
- NPI
- 1154701209
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Endodontics 1223E0200X
- License
- 058720 (NY)
- Practice address
- 8057 Brewerton Rd
Cicero, NY 13039-9585 - Phone
- (347) 400-9853
- NPI assigned
- Jun 4, 2015
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161107000168 | NY | Order and Referring Only - Dentist |
4688952047 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 058720 | NY | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 058720 | NY | |
| Endodontics | 1223E0200X | 058720 | NY | Yes |
Addresses
Primary practice location
8057 Brewerton Rd
Cicero, NY 13039-9585
Mailing address
829 N Salina St Apt 31
Syracuse, NY 13208-2672
Phone (347) 400-9853
Other providers in Cicero, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.