Individual provider Active NPI

Jason Walter Ciano, DDS, MPH

  • General Practice Dentistry
  • Lackawanna, NY
National Provider Identifier
1558045328
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
064082 Issued in NY
Practice address
790 Ridge Rd
Lackawanna, NY 14218-1629
Phone
(716) 828-9334
NPI assigned
Jun 12, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2025

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 064082 NY Primary

Addresses

Primary practice location

790 Ridge Rd
Lackawanna, NY 14218-1629

Mailing address

11 Creekside Ave
Buffalo, NY 14218-3547
Phone (516) 732-5944

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260422003456 NY Practitioner - Dentist 8527535921 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dentist
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

171 Sullys TRL
Pittsford, NY 14534-4557

790 Ridge Rd
Lackawanna, NY 14218-1629

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
064082NYMDGeneral Practice Dentistry

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": "1686528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741737600000",
    "number": "1558045328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 CREEKSIDE AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142183547",
            "telephone_number": "516-732-5944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 RIDGE RD",
            "city": "LACKAWANNA",
            "state": "NY",
            "postal_code": "142181629",
            "telephone_number": "716-828-9334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIANO",
        "first_name": "JASON",
        "middle_name": "WALTER",
        "name_prefix": "Dr.",
        "credential": "DDS, MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-12",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "064082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lackawanna, NY

Sources for this page

Verify at the official NPI Registry.