Individual provider Active NPI

Jennifer Paress Caroline, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Philadelphia, PA
National Provider Identifier
1447698519
Registry record updated Jun 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DS039509 Issued in PA
Practice address
3400 Spruce St
Philadelphia, PA 19104-4206
Phone
(215) 662-3580
NPI assigned
Jun 11, 2013
Last updated
Jun 11, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DS039509 PA Primary

Addresses

Primary practice location

3400 Spruce St
Philadelphia, PA 19104-4206

Mailing address

3400 Spruce St
Philadelphia, PA 19104-4206
Phone (215) 662-3580

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190722001201 TX Practitioner - Oral SurgeryPractitioner - Maxillofacial Surgery 1052604592 Reassigns benefits to 1 organization
I20220927001674 CA Practitioner - Oral Surgery 1052604592 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
DS039509PAMDOral and Maxillofacial Surgery (Dentist)
124CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
TMH Physician Associates PLLC CurrentSince Jul 1, 2019 Accepting new patients
TMH Physician Associates PLLC CurrentSince Jul 1, 2019 Accepting new patients
Makan Tarzana Dental Corporation Oral and Maxillofacial Surgery CurrentSince Sep 13, 2022 Accepting new patients
Houston Methodist Oral and Maxillofacial Surgeons, PLLC Past Accepting new patients

Locations

18372 Clark St
Ste 224
Tarzana, CA 91356
Phone (818) 996-1200

6550 Fannin St
#1280
Houston, TX 77030
Phone (713) 441-5577

6550 Fannin St
Ste 447
Houston, TX 77030
Phone (713) 441-0633

7575 San Felipe St
Ste 155
Houston, TX 77063
Phone (713) 266-9955

Interoperability endpoints

  • Direct secure messaging: jcaroline853319@direct.memorialcare.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1370908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370908800000",
    "number": "1447698519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206",
            "telephone_number": "215-662-3580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206",
            "telephone_number": "215-662-3580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAROLINE",
        "first_name": "JENNIFER",
        "middle_name": "PARESS",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-11",
        "last_updated": "2013-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS039509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.