Active NPI
Jeremiah Ricketson
- Oral and Maxillofacial Surgery (Dentist)
- West Hartford, CT
National Provider Identifier
1659933620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 2.013969
- Practice address
- 928 Farmington Ave
West Hartford, CT 06107-2227 - Phone
- (860) 232-4606
- NPI assigned
- Jul 1, 2019
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 2.013969 | CT | Primary |
Addresses
Primary practice location
928 Farmington Ave
West Hartford, CT 06107-2227
Mailing address
1011 N University Ave
Ann Arbor, MI 48109-1078
Phone (734) 764-1568
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210423000997 | MI | Order and Referring Only - Oral Surgery | 7012325483 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2.013969 | CT | MD | Oral and Maxillofacial Surgery (Dentist) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750896000000",
"number": "1659933620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1011 N UNIVERSITY AVE",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481091078",
"telephone_number": "734-764-1568",
"fax_number": "734-615-1415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "928 FARMINGTON AVE",
"city": "WEST HARTFORD",
"state": "CT",
"postal_code": "061072227",
"telephone_number": "860-232-4606"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICKETSON",
"first_name": "JEREMIAH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-01",
"last_updated": "2025-06-26",
"certification_date": "2025-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "CT",
"license": "2.013969",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Hartford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.