Individual provider Active NPI

Jordan Zeidman, DDS

  • General Practice Dentistry
  • Milford, CT
National Provider Identifier
1194344549
Registry record updated Jun 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
13193 Issued in CT
Practice address
55 Old Gate LN
Milford, CT 06460-3612
Phone
(203) 878-6699
NPI assigned
Apr 15, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2024

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 13193 CT Primary

Addresses

Primary practice location

55 Old Gate LN
Milford, CT 06460-3612

Mailing address

26 Visconti St
Norwalk, CT 06851-4035
Phone (631) 875-0260

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20210803001083 CT Order and Referring Only - DentistPractitioner - Dentist 5294139994

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13193CTMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Sensitive Care Cosmetic & Family Dentistry LLC General Practice PastSince Jun 9, 2024 Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1586908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1194344549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 VISCONTI ST",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068514035",
            "telephone_number": "631-875-0260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 OLD GATE LN",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064603612",
            "telephone_number": "203-878-6699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZEIDMAN",
        "first_name": "JORDAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-15",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "13193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milford, CT

Sources for this page

Verify at the official NPI Registry.