Priscilla Andalia

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS042774 Issued in PA

Practice address

3458 Neely Rd
Joint Base MDL, NJ 08641-5312

Phone

(609) 754-9297

NPI assigned

Apr 28, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1588032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630368000000",
    "number": "1306467667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 MILLER HILL RD",
            "city": "CARMEL",
            "state": "NY",
            "postal_code": "105123307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3458 NEELY RD",
            "city": "JOINT BASE MDL",
            "state": "NJ",
            "postal_code": "086415312",
            "telephone_number": "609-754-9297"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1065 W. Perimeter Road",
            "address_purpose": "LOCATION",
            "city": "JB Andrews",
            "state": "MD",
            "postal_code": "20762",
            "country_code": "US",
            "telephone_number": "240-612-2633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDALIA",
        "first_name": "PRISCILLA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-28",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS042774",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 87TH Medgrp-JB McGuire-Dix-Lakehurst
• Tauna Boatman-Cross
• Erin Kaye Boral, PHARMD
• Building New Legacies
• Daniel W Cline, DO
• Tarun Ganguly, DO

• General Practice Dentistry in Joint Base MDL, NJ
• Providers in Joint Base MDL, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; 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.