Active NPI
Krystin Ann Bandola, DMD, MD
- Oral and Maxillofacial Pathology Dentistry
- Hillsborough, NJ
National Provider Identifier
1407876212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Pathology Dentistry
- License
- 22D102154800
- Practice address
- 202 Towne Centre Dr
Hillsborough, NJ 08844-4693 - Phone
- (908) 359-1067
- Fax
- (908) 359-6467
- NPI assigned
- Jul 21, 2006
- Last updated
- Jan 9, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Oral and Maxillofacial Pathology Dentistry | 1223P0106X | 22D102154800 | NJ | Primary |
Addresses
Primary practice location
202 Towne Centre Dr
Hillsborough, NJ 08844-4693
Mailing address
202 Towne Centre Dr
Hillsborough, NJ 08844-4693
Phone (908) 359-1067
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 10, 2021 through Jun 10, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22D102154800 | NJ | MD | Oral and Maxillofacial Pathology Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420761600000",
"number": "1407876212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 TOWNE CENTRE DR",
"city": "HILLSBOROUGH",
"state": "NJ",
"postal_code": "088444693",
"telephone_number": "908-359-1067",
"fax_number": "908-359-6467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 TOWNE CENTRE DR",
"city": "HILLSBOROUGH",
"state": "NJ",
"postal_code": "088444693",
"telephone_number": "908-359-1067",
"fax_number": "908-359-6467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANDOLA",
"first_name": "KRYSTIN",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "DMD, MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-21",
"last_updated": "2015-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0106X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Pathology",
"state": "NJ",
"license": "22D102154800",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hillsborough, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.