Individual provider Active NPI

Venetia J Zervos, DDS

  • General Practice Dentistry
  • Mount Laurel, NJ
National Provider Identifier
1467670877
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D17105 Issued in NJ
Practice address
817 S Church St
Mount Laurel, NJ 08054-2503
Phone
(856) 778-2700
NPI assigned
Apr 23, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D17105 NJ Primary

Addresses

Primary practice location

817 S Church St
Mount Laurel, NJ 08054-2503

Mailing address

817 S Church St
Mount Laurel, NJ 08054-2503
Phone (856) 778-2700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20150701000311 NJ Order and Referring Only - DentistPractitioner - Dentist 2466764683

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D17105NJMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Church Street Family and Cosmetic Dentistry General Practice Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467670877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 S CHURCH ST",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080542503",
            "telephone_number": "856-778-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 S CHURCH ST",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080542503",
            "telephone_number": "856-778-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZERVOS",
        "first_name": "VENETIA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "D17105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Laurel, NJ

Sources for this page

Verify at the official NPI Registry.