NPIMap

Anas M Fatayer, DMD

Individual provider Active NPI Endodontics · Westlake, OH

NPI 1710247366 · NPPES record last updated Oct 11, 2021

Key facts

NPI
1710247366
Entity type
Individual (NPI type 1)
Primary specialty
Endodontics 1223E0200X
License
30.026035 (OH)
Practice address
30400 Detroit Rd Ste 209
Westlake, OH 44145-1855
Phone
(440) 808-9990
Fax
(440) 808-9992
NPI assigned
May 16, 2012
Sex
Male
Sole proprietor
No

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
30.026035OHMDEndodontist
DS039476PAMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Westlake Endodontics LLC Current
since Oct 17, 2021		 Accepting new patients
Associated Dental Specialists Endodontics Past
since Feb 1, 2020		 Accepting new patients

Locations

30400 Detroit Rd
Ste 209
Westlake, OH 44145
Phone (412) 407-2723

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DS039476 PA
Endodontics 1223E0200X DS039476 PA
Endodontics 1223E0200X 30.026035 OH Yes

Addresses

Primary practice location

30400 Detroit Rd Ste 209
Westlake, OH 44145-1855

Mailing address

30400 Detroit Rd Ste 209
Westlake, OH 44145-1855
Phone (440) 808-9990

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 11, 2021.

{
    "created_epoch": "1337126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633910400000",
    "number": "1710247366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30400 DETROIT RD STE 209",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441451855",
            "telephone_number": "440-808-9990",
            "fax_number": "440-808-9992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30400 DETROIT RD STE 209",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441451855",
            "telephone_number": "440-808-9990",
            "fax_number": "440-808-9992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FATAYER",
        "first_name": "ANAS",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-16",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS039476",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "PA",
            "license": "DS039476",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "OH",
            "license": "30.026035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westlake, OH

All providers in Westlake, OH · Endodontics in Ohio

Sources for this page

Verify at the official NPI Registry.