Jessica Frances Defazio, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

64173 Issued in CA

Practice address

345 E 24TH St # 9W
New York, NY 10010-4020

Phone

(414) 491-4003

NPI assigned

Jan 23, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Jessica Frances Kravit Former name

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1390435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441238400000",
    "number": "1770906992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3776 DOVE ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921033979",
            "telephone_number": "414-491-4003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 E 24TH ST # 9W",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100104020",
            "telephone_number": "414-491-4003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEFAZIO",
        "first_name": "JESSICA",
        "middle_name": "FRANCES",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-01-23",
        "last_updated": "2015-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "00000000000000000000",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "64173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "KRAVIT",
            "middle_name": "FRANCES",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Selin Deeskinazis, PSY.D.
• Mireille Deetjen, LPN
• Albert Defabritus, MD
• Kaitlin L Defalco
• Jennifer Lynn Defaria
• Lisa M Defeciani, LCSW-R
• Joseph Louis Defedele, R.PH.
• Amy Defelice
• Joseph F Defeo, MD
• Michelle Christine Defeo, LMSW

• All providers in New York, NY
• Pediatric Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2015; 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.

Verify at the official NPI Registry.