NPIMap

Individual provider Active NPI

Ryan Dominic Menezes, DMD

  • General Practice Dentistry
  • Philadelphia, PA
National Provider Identifier
1609121482
Registry record updated Nov 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
22DI02508900 Issued in NJ
Practice address
3945 Chestnut St
Apt 907
Philadelphia, PA 19104-3621
Phone
(312) 404-1754
NPI assigned
Jul 18, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DS039247 PA
General Practice Dentistry 1223G0001X 22DI02508900 NJ Primary

Addresses

Primary practice location

3945 Chestnut St
Apt 907
Philadelphia, PA 19104-3621

Mailing address

3945 Chestnut St
Apt 907
Philadelphia, PA 19104-3621

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DS039247PAMDDentist
22DI02508900NJMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Cinco Ranch Smiles & Braces PLLC General Practice Current 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": "1342569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352592000000",
    "number": "1609121482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3945 CHESTNUT ST",
            "address_2": "APT 907",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191043621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3945 CHESTNUT ST",
            "address_2": "APT 907",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191043621",
            "telephone_number": "312-404-1754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENEZES",
        "first_name": "RYAN",
        "middle_name": "DOMINIC",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-18",
        "last_updated": "2012-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS039247",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02508900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2012; 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.