Individual provider Active NPI

Ira Spritzer, DDS

  • Dentist
  • Winslow, AZ
National Provider Identifier
1396869434
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
22DI01421000 Issued in NJ
Practice address
500 Indiana Ave
Winslow, AZ 86047-2169
Phone
(928) 289-4646
NPI assigned
Mar 16, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 22DI01421000 NJ Primary

Addresses

Primary practice location

500 Indiana Ave
Winslow, AZ 86047-2169

Mailing address

500 Indiana Ave
Winslow, AZ 86047-2169

Other identifiers 1

IdentifierTypeStateIssuer
848749MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20161219002776 TX Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 0941581565

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22DI01421000NJMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1396869434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 INDIANA AVE",
            "city": "WINSLOW",
            "state": "AZ",
            "postal_code": "860472169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 INDIANA AVE",
            "city": "WINSLOW",
            "state": "AZ",
            "postal_code": "860472169",
            "telephone_number": "928-289-4646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPRITZER",
        "first_name": "IRA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-16",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI01421000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "848749",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winslow, AZ

Sources for this page

Verify at the official NPI Registry.