Individual provider Active NPI

Ernest Devan Ponraj, DDS

  • Dentist
  • Rockville, MD
National Provider Identifier
1700114097
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
14719 Issued in MD
Practice address
4 Taft CT Ste 150
Rockville, MD 20850-5582
Phone
(301) 598-7800
Fax
(301) 963-6300
NPI assigned
Nov 24, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 0401412323 VA
Dentist 122300000X DEN1001069 DC
Dentist 122300000X 14719 MD Primary

Addresses

Primary practice location

4 Taft CT Ste 150
Rockville, MD 20850-5582

Mailing address

4 Taft CT Ste 150
Rockville, MD 20850-5582
Phone (301) 598-7800

Other practice location 1

2277 Bel Pre Rd
Suite #212
Silver Spring, MD 20906-2200
Phone (301) 598-7800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20160725000057 MD Order and Referring Only - DentistPractitioner - Dentist 5496048746

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DEN1001069DCMDDentist
0401412323VAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Bel Pre Family Dental LLC CurrentSince Nov 10, 2024 Accepting new patients

Locations

4 Taft Ct
Ste 150
Rockville, MD 20850
Phone (301) 598-7800

2277 Bel Pre Rd
Ste 212
Silver Spring, MD 20906
Phone (301) 598-7800

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1259020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730937600000",
    "number": "1700114097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 TAFT CT STE 150",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208505582",
            "telephone_number": "301-598-7800",
            "fax_number": "301-963-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 TAFT CT STE 150",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208505582",
            "telephone_number": "301-598-7800",
            "fax_number": "301-963-6300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2277 Bel Pre Rd",
            "address_2": "Suite #212",
            "address_purpose": "LOCATION",
            "city": "Silver Spring",
            "state": "MD",
            "postal_code": "209062200",
            "country_code": "US",
            "telephone_number": "301-598-7800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PONRAJ",
        "first_name": "ERNEST",
        "middle_name": "DEVAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-11-24",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401412323",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "DC",
            "license": "DEN1001069",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "14719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

Verify at the official NPI Registry.