Active NPI
William Christian Bertram Desonne
- Pediatric Dentistry
- Deptford, NJ
National Provider Identifier
1386175149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 22DI02779600
- Practice address
- 1692 Clements Bridge Rd
Deptford, NJ 08096-3028 - Phone
- (856) 845-6198
- NPI assigned
- Mar 23, 2017
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 22DI02779600 | NJ | Primary |
Addresses
Primary practice location
1692 Clements Bridge Rd
Deptford, NJ 08096-3028
Mailing address
1692 Clements Bridge Rd
Deptford, NJ 08096-3028
Other practice location 1
1400 Pelham Parkway South
Jacobi Medical Center
Bronx, NY 10461
Phone (718) 918-3419
Other practice location 2
501 White Horse Pike
West Collingswood, NJ 08107-1729
Phone (856) 854-1509
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 |
|---|---|---|---|
| 22DI02779600 | NJ | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Roundup Pediatric Dentistry LLC | Current | Accepting new patients |
Locations
2300 Wrangleboro Rd
Ste 740
Mays Landing, NJ 08330
Phone (609) 829-3101
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.
-
- Dental Clinic/Center
- Mays Landing, NJ
- NPI 1730960550
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581552000000",
"number": "1386175149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1692 CLEMENTS BRIDGE RD",
"city": "DEPTFORD",
"state": "NJ",
"postal_code": "080963028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1692 CLEMENTS BRIDGE RD",
"city": "DEPTFORD",
"state": "NJ",
"postal_code": "080963028",
"telephone_number": "856-845-6198"
}
],
"practiceLocations": [
{
"address_1": "1400 Pelham Parkway South",
"address_2": "Jacobi Medical Center",
"address_purpose": "LOCATION",
"city": "Bronx",
"state": "NY",
"postal_code": "10461",
"country_code": "US",
"telephone_number": "718-918-3419",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "501 White Horse Pike",
"address_purpose": "LOCATION",
"city": "West Collingswood",
"state": "NJ",
"postal_code": "081071729",
"country_code": "US",
"telephone_number": "856-854-1509",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DESONNE",
"first_name": "WILLIAM",
"middle_name": "CHRISTIAN BERTRAM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-03-23",
"last_updated": "2020-02-13",
"certification_date": "2020-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NJ",
"license": "22DI02779600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Deptford, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.