NPIMap

Organization Active NPI

Akj Dental, DDS, LLC

  • Dentist
  • Lavale, MD
National Provider Identifier
1629423694
Registry record updated Apr 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
AKJ DENTAL, DDS, LLC
Practice address
12317 Winchester Rd SW
Ste 100
Lavale, MD 21502-6547
Phone
(240) 803-3487
Fax
(301) 729-2397
NPI assigned
Apr 27, 2016
Last updated
Apr 27, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2016

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

Authorized official

Name
Jason Bertollini
Title
PRS
Phone
(866) 273-8204

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Primary

Addresses

Primary practice location

12317 Winchester Rd SW
Ste 100
Lavale, MD 21502-6547

Mailing address

PO Box 3189
Syracuse, NY 13220-3189
Phone (866) 273-8204

National Provider Directory

National Provider Directory
Tax ID family
Akj Dental DDS LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

12317 Winchester Rd SW
Ste 100
Lavale, MD 21502
Phone (240) 803-3487

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1461715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461715200000",
    "number": "1629423694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3189",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132203189",
            "telephone_number": "866-273-8204",
            "fax_number": "315-410-5531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12317 WINCHESTER RD SW",
            "address_2": "STE 100",
            "city": "LAVALE",
            "state": "MD",
            "postal_code": "215026547",
            "telephone_number": "240-803-3487",
            "fax_number": "301-729-2397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AKJ DENTAL, DDS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-27",
        "last_updated": "2016-04-27",
        "status": "A",
        "authorized_official_last_name": "BERTOLLINI",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "PRS",
        "authorized_official_telephone_number": "866-273-8204"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lavale, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2016; 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.