Active NPI
Raymond B. Van Gennip, DDS, MSD
- Periodontics
- Silver Spring, MD
National Provider Identifier
1619009198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 12299
- Practice address
- 8630 Fenton St
Suite 212
Silver Spring, MD 20910-3806 - Phone
- (301) 565-8030
- NPI assigned
- Mar 11, 2007
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 12299 | MD | Primary |
Addresses
Primary practice location
8630 Fenton St
Suite 212
Silver Spring, MD 20910-3806
Mailing address
8630 Fenton St
Suite 212
Silver Spring, MD 20910-3806
Phone (301) 565-8030
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
| License | State | Type | Specialty |
|---|---|---|---|
| 12299 | MD | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619009198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8630 FENTON ST",
"address_2": "SUITE 212",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209103806",
"telephone_number": "301-565-8030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8630 FENTON ST",
"address_2": "SUITE 212",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209103806",
"telephone_number": "301-565-8030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN GENNIP",
"first_name": "RAYMOND",
"middle_name": "B.",
"name_prefix": "Dr.",
"credential": "DDS, MSD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MD",
"license": "12299",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Silver Spring, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.