Lisa Ann Jedacek, DMD, MPH

Primary specialty

Dental AnesthesiologyTaxonomy code 1223D0004X

License

0401418721 Issued in VA

Practice address

1400 Pelham Pkwy S
Bronx, NY 10461-1197

Phone

(718) 918-5000

NPI assigned

Feb 9, 2021

Last updated

Jul 9, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 9

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Beacon Dental Studio, PC

  • Dental Clinic/Center
  • Brooklyn, NY
  • NPI 1588323646
  NPD (past)
• Dinosaur Orthodontics PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Endicott, NY
  • NPI 1649043910
  NPD (past)
• Oliverie Dental LLC

  • Dental Clinic/Center
  • Wall, NJ
  • NPI 1407179237
  NPD (past)

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

{
    "created_epoch": "1612828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720483200000",
    "number": "1528650710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1817 MAYFLOWER AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104614103",
            "telephone_number": "440-665-3973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 PELHAM PKWY S",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104611197",
            "telephone_number": "718-918-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1516 NJ-138",
            "address_2": "Suite #1a",
            "address_purpose": "LOCATION",
            "city": "Wall Township",
            "state": "NJ",
            "postal_code": "07719",
            "country_code": "US",
            "telephone_number": "732-681-5544",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1700 Monroe St",
            "address_purpose": "LOCATION",
            "city": "Endicott",
            "state": "NY",
            "postal_code": "137605512",
            "country_code": "US",
            "telephone_number": "607-953-4445",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "378 Atlantic Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112175000",
            "country_code": "US",
            "telephone_number": "718-412-5221",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "378 Atlantic Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112175000",
            "country_code": "US",
            "telephone_number": "718-412-5221",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5002 Airport Rd NW # 30",
            "address_purpose": "LOCATION",
            "city": "Roanoke",
            "state": "VA",
            "postal_code": "240121607",
            "country_code": "US",
            "telephone_number": "540-900-4782",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1817 Mayflower Ave",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104614103",
            "country_code": "US",
            "telephone_number": "440-665-3973",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11934 W Broad St Ste 120",
            "address_purpose": "LOCATION",
            "city": "Henrico",
            "state": "VA",
            "postal_code": "232331100",
            "country_code": "US",
            "telephone_number": "804-293-2662",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4749 S Baldwin Rd",
            "address_purpose": "LOCATION",
            "city": "Lake Orion",
            "state": "MI",
            "postal_code": "483592114",
            "country_code": "US",
            "telephone_number": "248-422-0555",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2165 Cunningham Dr",
            "address_purpose": "LOCATION",
            "city": "Hampton",
            "state": "VA",
            "postal_code": "236662569",
            "country_code": "US",
            "telephone_number": "757-755-8846",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JEDACEK",
        "first_name": "LISA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DMD, MPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-09",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI03015700",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401418721",
            "primary": false
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "MA",
            "license": "DN10000315",
            "primary": false
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "MI",
            "license": "2901602093",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN10000315",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901602093",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.027607",
            "primary": false
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "OH",
            "license": "30.027607",
            "primary": false
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "VA",
            "license": "0401418721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stanley Jean
• Tinaya Jean
• Maya Jeannine
• Kenia Jeanniton, LCSW
• Harry Smith Jeanty
• Nadira Melissa Jeeuth
• Shakia Jeffers, LPN
• Jefferson Pharma LLC (Feel Good Pharmacy)
• Christopher T Jefferson, LMSW
• Karen Jefferson, RPA

• Dental Anesthesiology in Bronx, NY
• Providers in Bronx, NY by specialty
• Dental Anesthesiology in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.