Active NPI
Jose Enrique Ibanez-Pabon, DMD
- General Practice Dentistry
- Bolling Afb, DC
National Provider Identifier
1417094962
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 21179
- Practice address
- 238 Brookley Ave
Bolling Afb, DC 20332-0701 - Phone
- (202) 767-5382
- Fax
- (202) 767-4091
- NPI assigned
- Jan 31, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 21179 | OH | Primary |
Addresses
Primary practice location
238 Brookley Ave
Bolling Afb, DC 20332-0701
Mailing address
5483 Ashleigh Rd
Fairfax, VA 22030-7269
Phone (703) 681-6464
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 |
|---|---|---|---|
| 21179 | OH | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417094962",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5483 ASHLEIGH RD",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220307269",
"telephone_number": "703-681-6464",
"fax_number": "703-681-6152"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "238 BROOKLEY AVE",
"city": "BOLLING AFB",
"state": "DC",
"postal_code": "203320701",
"telephone_number": "202-767-5382",
"fax_number": "202-767-4091"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBANEZ-PABON",
"first_name": "JOSE",
"middle_name": "ENRIQUE",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OH",
"license": "21179",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bolling Afb, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.