Active NPI
Jay Richard Van Dusen, D.D.S.
- General Practice Dentistry
- Silver Creek, NY
National Provider Identifier
1477797637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 50055130
- Practice address
- 33 Main St
Silver Creek, NY 14136-1473 - Phone
- (716) 934-4814
- NPI assigned
- Apr 30, 2009
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 50055130 | NY | Primary |
Addresses
Primary practice location
33 Main St
Silver Creek, NY 14136-1473
Mailing address
4137 Calkins Rd
Youngstown, NY 14174-9718
Phone (716) 940-4545
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200401002630 | NY | Order and Referring Only - Dentist | 6305275058 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50055130 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406073600000",
"number": "1477797637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4137 CALKINS RD",
"city": "YOUNGSTOWN",
"state": "NY",
"postal_code": "141749718",
"telephone_number": "716-940-4545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33 MAIN ST",
"city": "SILVER CREEK",
"state": "NY",
"postal_code": "141361473",
"telephone_number": "716-934-4814"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN DUSEN",
"first_name": "JAY",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-04-30",
"last_updated": "2014-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "50055130",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Silver Creek, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.