Individual provider Active NPI

Gary Dadaian, D.M.D.

  • General Practice Dentistry
  • Cresskill, NJ
National Provider Identifier
1730213679
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
11854 Issued in NJ
Practice address
100 Union Ave
Cresskill, NJ 07626-2141
Phone
(201) 569-3555
NPI assigned
Mar 15, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 11854 NJ Primary

Addresses

Primary practice location

100 Union Ave
Cresskill, NJ 07626-2141

Mailing address

100 Union Ave
Cresskill, NJ 07626-2141
Phone (201) 569-3555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20160421002252 NJ Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 7517266729

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11854NJMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730213679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 UNION AVE",
            "city": "CRESSKILL",
            "state": "NJ",
            "postal_code": "076262141",
            "telephone_number": "201-569-3555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 UNION AVE",
            "city": "CRESSKILL",
            "state": "NJ",
            "postal_code": "076262141",
            "telephone_number": "201-569-3555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DADAIAN",
        "first_name": "GARY",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "11854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cresskill, NJ

Sources for this page

Verify at the official NPI Registry.