Individual provider Active NPI

Jay Paresh Dalal, D.M.D

  • Oral and Maxillofacial Surgery (Dentist)
  • Philadelphia, PA
National Provider Identifier
1669216727
Registry record updated Jun 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DS044652 Issued in PA
Practice address
909 Walnut St Ste 300
Philadelphia, PA 19107-5211
Phone
(860) 904-3695
NPI assigned
Jun 24, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DS044652 PA Primary

Addresses

Primary practice location

909 Walnut St Ste 300
Philadelphia, PA 19107-5211

Mailing address

909 Walnut St Ste 300
Philadelphia, PA 19107-5211
Phone (860) 904-3695

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20240712003369 PA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 0143765255

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DS044652PAMDOral and Maxillofacial Surgery (Dentist)

NPI Registry JSON

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

{
    "created_epoch": "1719187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1669216727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 WALNUT ST STE 300",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075211",
            "telephone_number": "860-904-3695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 WALNUT ST STE 300",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075211",
            "telephone_number": "860-904-3695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALAL",
        "first_name": "JAY",
        "middle_name": "PARESH",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-24",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS044652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.