Individual provider Active NPI

Tarek El Kerdani, DDS,MSD,FACP

  • Prosthodontics
  • Iowa City, IA
National Provider Identifier
1629378807
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
40178 Issued in IA
Practice address
322 Dental Science BLDG S
Iowa City, IA 52242-1001
Phone
(319) 335-7440
Fax
(319) 335-7451
NPI assigned
Oct 22, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthodontics 1223P0700X 40178 IA Primary
Dentist 122300000X 16792 MI

Addresses

Primary practice location

322 Dental Science BLDG S
Iowa City, IA 52242-1001

Mailing address

322 Dental Science BLDG S
Iowa City, IA 52242-1001
Phone (319) 335-7440

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20181102000766 IA Practitioner - Oral Surgery 2062765308 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16792MIMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
State University of Iowa Dentist CurrentSince Oct 1, 2018 Accepting new patients
State University of Iowa CurrentSince Oct 1, 2018 Accepting new patients

Locations

322 Dental Science S
Iowa City, IA 52242
Phone (319) 335-7342

200 Hawkins Dr
Iowa City, IA 52242
Phone (319) 356-1616

322 Dental Science S
Bldg S
Iowa City, IA 52242
Phone (319) 384-1139

Organizations & group practices 2

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": "1287705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1629378807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 DENTAL SCIENCE BLDG S",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421001",
            "telephone_number": "319-335-7440",
            "fax_number": "319-335-7451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 DENTAL SCIENCE BLDG S",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421001",
            "telephone_number": "319-335-7440",
            "fax_number": "319-335-7451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EL KERDANI",
        "first_name": "TAREK",
        "credential": "DDS,MSD,FACP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-22",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "IA",
            "license": "40178",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "16792",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Iowa City, IA

Sources for this page

Verify at the official NPI Registry.