Active NPI
Nicholas Anthony Avianto, DMD
- Pediatric Dentistry
- Bloomfield, NJ
National Provider Identifier
1831758663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 22DI02859400
- Practice address
- 301 Belleville Ave
Bloomfield, NJ 07003-3647 - Phone
- (551) 227-2551
- NPI assigned
- Jun 5, 2019
- Last updated
- Jan 17, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 22DI02859400 | NJ | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X | NU |
Addresses
Primary practice location
301 Belleville Ave
Bloomfield, NJ 07003-3647
Mailing address
56 Rodney PL
Demarest, NJ 07627-1625
Phone (201) 655-4122
Other practice location 1
13123 E 16th Ave # 240
Aurora, CO 80045-7106
Phone (720) 777-4044
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI02859400 | NJ | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ridgewood Valley Dentistry LLC | Current | Accepting new patients |
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.
-
dba Ridgewood Valley Pediatric Dentistry
- Dental Clinic/Center
- Glen Rock, NJ
- NPI 1992534614
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673913600000",
"number": "1831758663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "56 RODNEY PL",
"city": "DEMAREST",
"state": "NJ",
"postal_code": "076271625",
"telephone_number": "201-655-4122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 BELLEVILLE AVE",
"city": "BLOOMFIELD",
"state": "NJ",
"postal_code": "070033647",
"telephone_number": "551-227-2551"
}
],
"practiceLocations": [
{
"address_1": "13123 E 16th Ave # 240",
"address_purpose": "LOCATION",
"city": "Aurora",
"state": "CO",
"postal_code": "800457106",
"country_code": "US",
"telephone_number": "720-777-4044",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "AVIANTO",
"first_name": "NICHOLAS",
"middle_name": "ANTHONY",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-06-05",
"last_updated": "2023-01-17",
"certification_date": "2023-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NJ",
"license": "22DI02859400",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomfield, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.