Individual provider Active NPI

William David Moncevicz, DMD

  • General Practice Dentistry
  • Wilmington, DE
National Provider Identifier
1174743199
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2004211989 Issued in DE
Practice address
3521 Silverside Rd
Quillen Building Suite 2H
Wilmington, DE 19810-4900
Phone
(302) 477-9779
Fax
(302) 477-9119
NPI assigned
May 1, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2004211989 DE Primary

Addresses

Primary practice location

3521 Silverside Rd
Quillen Building Suite 2H
Wilmington, DE 19810-4900

Mailing address

3521 Silverside Rd
Quillen Building Suite 2H
Wilmington, DE 19810-4900
Phone (302) 477-9779

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
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

Enrollment IDStateProvider typePAC IDDetails
I20150721001695 DE Order and Referring Only - DentistPractitioner - Dentist 3274846134

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2004211989DEMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174743199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3521 SILVERSIDE RD",
            "address_2": "QUILLEN BUILDING SUITE 2H",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198104900",
            "telephone_number": "302-477-9779",
            "fax_number": "302-477-9119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3521 SILVERSIDE RD",
            "address_2": "QUILLEN BUILDING SUITE 2H",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198104900",
            "telephone_number": "302-477-9779",
            "fax_number": "302-477-9119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONCEVICZ",
        "first_name": "WILLIAM",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "DE",
            "license": "2004211989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, DE

Sources for this page

Verify at the official NPI Registry.