Individual provider Active NPI

Imani Nia Molock-Smith, D.D.S

  • Dentist
  • Lindenwold, NJ
National Provider Identifier
1841424025
Registry record updated May 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
22DI02407600 Issued in NJ
Practice address
98 Oak St
Apt 4211
Lindenwold, NJ 08021-2483
Phone
(215) 620-1342
NPI assigned
May 4, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 7, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DS037815 PA
Dentist 122300000X 22DI02407600 NJ Primary

Addresses

Primary practice location

98 Oak St
Apt 4211
Lindenwold, NJ 08021-2483

Mailing address

98 Oak St
Apt 4211
Lindenwold, NJ 08021-2483
Phone (215) 620-1342

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
I20150610001668 NJ Order and Referring Only - DentistPractitioner - Dentist 1052632403

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DS037815PAMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1241395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273190400000",
    "number": "1841424025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98 OAK ST",
            "address_2": "APT 4211",
            "city": "LINDENWOLD",
            "state": "NJ",
            "postal_code": "080212483",
            "telephone_number": "215-620-1342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98 OAK ST",
            "address_2": "APT 4211",
            "city": "LINDENWOLD",
            "state": "NJ",
            "postal_code": "080212483",
            "telephone_number": "215-620-1342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLOCK-SMITH",
        "first_name": "IMANI",
        "middle_name": "NIA",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-04",
        "last_updated": "2010-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS037815",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02407600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lindenwold, NJ

Sources for this page

Verify at the official NPI Registry.