Active NPI
Jennifer Rochelle Emdadi, DDS
- General Practice Dentistry
- Shreveport, LA
National Provider Identifier
1205197399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DO NOT APPLY
- Practice address
- 510 E. Stoner Ave
Overton Brooks VA Medical Center
Shreveport, LA 71101 - Phone
- (318) 221-8411
- NPI assigned
- Jun 5, 2012
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DO NOT APPLY | CA | Primary |
Addresses
Primary practice location
510 E. Stoner Ave
Overton Brooks VA Medical Center
Shreveport, LA 71101
Mailing address
1301 Coates Bluff Dr
Apt#622
Shreveport, LA 71104-2841
Phone (951) 533-2534
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DO NOT APPLY | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406764800000",
"number": "1205197399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1301 COATES BLUFF DR",
"address_2": "APT#622",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711042841",
"telephone_number": "951-533-2534"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 E. STONER AVE",
"address_2": "OVERTON BROOKS VA MEDICAL CENTER",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "71101",
"telephone_number": "318-221-8411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EMDADI",
"first_name": "JENNIFER",
"middle_name": "ROCHELLE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-05",
"last_updated": "2014-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "DO NOT APPLY",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.