Jack Ross Acheatel

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

20143 Issued in CA

Practice address

18856 Roscoe Blvd
Northridge, CA 91324

Phone

(818) 885-7116

NPI assigned

Dec 3, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1291334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291334400000",
    "number": "1194027698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18856 ROSCOE BLVD",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "91324",
            "telephone_number": "818-885-7116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18856 ROSCOE BLVD",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "91324",
            "telephone_number": "818-885-7116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ACHEATEL",
        "first_name": "JACK",
        "middle_name": "ROSS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-12-03",
        "last_updated": "2010-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "20143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Takoosh Abrahamian, MFT
• Tina Abramian, PHARMD
• Frank Gregory Abt, P.A.
• Abul H. Shirazi, MD, Inc.
• Ronald P. Accomazzo, MD
• Denise Sue Ackerman, M.S., R.D.
• Active Home Health
• Active Life, LLC
• Melina Adamian, DDS, MS, CERT
• Tara Yvonne Adams-Clarke, DPT

• All providers in Northridge, CA
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.