NPIMap

Individual provider Active NPI

Mariana C Elwell, DDS

  • General Practice Dentistry
  • Bridgeton, NJ
National Provider Identifier
1265421986
Registry record updated Jun 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
22DI02582800 Issued in NJ
Practice address
6 Atlantic Street
Bridgeton, NJ 08302
Phone
(856) 455-4095
Fax
(856) 455-5292
NPI assigned
Oct 14, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DD2554 NM
General Practice Dentistry 1223G0001X DS039544 PA
General Practice Dentistry 1223G0001X 22DI02582800 NJ Primary

Addresses

Primary practice location

6 Atlantic Street
Bridgeton, NJ 08302

Mailing address

6 Atlantic Street
Bridgeton, NJ 08302
Phone (856) 455-4095

Other names 1

  • Concha M. Adamich Former name

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
DD2554NMMDDentist
DS039544PAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Lassen Dental LLC General Practice Past Accepting new patients
Dr. Henry Quest D.M.D. PC General Practice Past Accepting new patients

Organizations & group practices 2

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": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529452800000",
    "number": "1265421986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 ATLANTIC STREET",
            "city": "BRIDGETON",
            "state": "NJ",
            "postal_code": "08302",
            "telephone_number": "856-455-4095",
            "fax_number": "856-455-5292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 ATLANTIC STREET",
            "city": "BRIDGETON",
            "state": "NJ",
            "postal_code": "08302",
            "telephone_number": "856-455-4095",
            "fax_number": "856-455-5292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELWELL",
        "first_name": "MARIANA",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-14",
        "last_updated": "2018-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD2554",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS039544",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02582800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CONCHA",
            "last_name": "ADAMICH",
            "middle_name": "M.",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bridgeton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; 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.