Individual provider Active NPI

Fred C. Vankeuren, D.M.D.

  • General Practice Dentistry
  • Sparta, NJ
National Provider Identifier
1225194459
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DIO 16523 Issued in NJ
Practice address
6 Seminary LN
Sparta, NJ 07871-2404
Phone
(973) 729-3700
Fax
(973) 726-9549
NPI assigned
Dec 30, 2006
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 DIO 16523 NJ Primary

Addresses

Primary practice location

6 Seminary LN
Sparta, NJ 07871-2404

Mailing address

6 Seminary LN
Sparta, NJ 07871-2404
Phone (973) 729-3700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20150819006537 NJ Order and Referring Only - DentistPractitioner - Dentist 8224343314

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DIO 16523NJMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1167436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1225194459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 SEMINARY LN",
            "city": "SPARTA",
            "state": "NJ",
            "postal_code": "078712404",
            "telephone_number": "973-729-3700",
            "fax_number": "973-726-9549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 SEMINARY LN",
            "city": "SPARTA",
            "state": "NJ",
            "postal_code": "078712404",
            "telephone_number": "973-729-3700",
            "fax_number": "973-726-9549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANKEUREN",
        "first_name": "FRED",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "DIO 16523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sparta, NJ

Sources for this page

Verify at the official NPI Registry.