Mayra Modesto-Garrido, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI01825501 Issued in NJ

Practice address

266 Harristown Rd
Suite 102
Glen Rock, NJ 07452-3302

Phone

(201) 652-0400

Fax

(201) 447-5762

NPI assigned

Dec 15, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Excel Dentistry, P.C.

  • General Practice Dentistry
  • Glen Rock, NJ
  • NPI 1982766853
  NPD (past) Authorized official

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1568524528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "266 HARRISTOWN RD",
            "address_2": "SUITE 102",
            "city": "GLEN ROCK",
            "state": "NJ",
            "postal_code": "074523302",
            "telephone_number": "201-652-0400",
            "fax_number": "201-447-5762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "266 HARRISTOWN RD",
            "address_2": "SUITE 102",
            "city": "GLEN ROCK",
            "state": "NJ",
            "postal_code": "074523302",
            "telephone_number": "201-652-0400",
            "fax_number": "201-447-5762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODESTO-GARRIDO",
        "first_name": "MAYRA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-15",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI01825501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0066028",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6037704",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "898217",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kunal Yatish Merchant, M.D.
• Teresa Michaud, DDS
• Lisa Miraglia-Ranoff, RPH
• David A Mitnick, M.D.
• MMB Transportation Services, LLC
• Aryam Modesto, D.M.D.
• Monarch Anesthesia of Jersey City, LLC
• More Eyecare II, LLC
• Michele Anne Morelli-Weiss, OTR/L
• Kelly D Morris, LMFT

• General Practice Dentistry in Glen Rock, NJ
• Providers in Glen Rock, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; 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.

Verify at the official NPI Registry.