Active NPI
Jonathan A Waasdorp, DMD
- Periodontics
- King of Prussia, PA
National Provider Identifier
1619105772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DS037114
- Practice address
- 10112 Valley Forge Cir
Suite 112
King of Prussia, PA 19406-1111 - Phone
- (610) 783-0822
- NPI assigned
- Jun 29, 2009
- 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 | DS037114 | PA | Primary |
Addresses
Primary practice location
10112 Valley Forge Cir
Suite 112
King of Prussia, PA 19406-1111
Mailing address
10112 Valley Forge Circle
Suite 112
King of Prussia, PA 19406
Phone (610) 783-0822
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 |
|---|---|---|---|
| DS037114 | PA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246233600000",
"number": "1619105772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10112 VALLEY FORGE CIRCLE",
"address_2": "SUITE 112",
"city": "KING OF PRUSSIA",
"state": "PA",
"postal_code": "19406",
"telephone_number": "610-783-0822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10112 VALLEY FORGE CIR",
"address_2": "SUITE 112",
"city": "KING OF PRUSSIA",
"state": "PA",
"postal_code": "194061111",
"telephone_number": "610-783-0822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAASDORP",
"first_name": "JONATHAN",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-06-29",
"last_updated": "2009-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "PA",
"license": "DS037114",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in King of Prussia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.