Active NPI
Jesse Murillo, DDS
- Periodontics
- JB MDL, NJ
National Provider Identifier
1164528949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 19325
- Practice address
- 3458 Neely Rd
JB MDL, NJ 08641 - Phone
- (609) 754-3786
- NPI assigned
- Sep 16, 2006
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 19325 | TX | Primary |
Addresses
Primary practice location
3458 Neely Rd
JB MDL, NJ 08641
Mailing address
3458 Neely Rd
JB MDL, NJ 08641-5312
Phone (609) 754-3786
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 19325 | Other | TX | DENTAL LICENCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140714000266 | FL | Order and Referring Only - Oral Surgery | 9335364074 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1526601600000",
"number": "1164528949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3458 NEELY RD",
"city": "JB MDL",
"state": "NJ",
"postal_code": "086415312",
"telephone_number": "609-754-3786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3458 NEELY RD",
"city": "JB MDL",
"state": "NJ",
"postal_code": "08641",
"telephone_number": "609-754-3786"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MURILLO",
"first_name": "JESSE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-16",
"last_updated": "2018-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TX",
"license": "19325",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENCE",
"identifier": "19325",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in JB MDL, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2018; 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.