Assad Z Tanios, DDS

Individual provider Active NPI General Practice Dentistry · Beachwood, NJ

NPI 1174739015 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1174739015
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
19038 (NJ)
Practice address
659 Atlantic City Blvd
Beachwood, NJ 08722-4007
Phone
(732) 349-0555
NPI assigned
May 15, 2007
Sex
Male
Sole proprietor
No

Organizations & group practices 1

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.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20160519001888 NJ Order and Referring Only - Dentist
Practitioner - Dentist
2365731072

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
19038NJMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Beachwood Dental Arts, LLC Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 19038 NJ Yes

Addresses

Primary practice location

659 Atlantic City Blvd
Beachwood, NJ 08722-4007

Mailing address

5 Eldorado Way
Monroe, NJ 08831-4508
Phone (732) 521-5030

Other providers in Beachwood, NJ

All providers in Beachwood, NJ · General Practice Dentistry in New Jersey

Sources for this page

Verify at the official NPI Registry.