Rejuvenate Dental Sleep Medicine

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI01825500 Issued in NJ

Legal business name

REJUVENATE DENTAL SLEEP MEDICINE

Practice address

266 Harristown Rd
Suite 102
Glen Rock, NJ 07452-3302

Phone

(201) 652-0400

Fax

(201) 447-5762

NPI assigned

May 31, 2013

Last updated

Jun 27, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mayra Modesto-Garrido, D.D.S.NPI 1568524528

Title

Dentist

Phone

(201) 652-0400

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mayra Modesto-Garrido, D.D.S.

  • General Practice Dentistry
  • Glen Rock, NJ
  • NPI 1568524528
  Authorized official Same address or phone
• Aryam Modesto, D.M.D.

  • Dentist
  • Glen Rock, NJ
  • NPI 1891066486
  NPD (past)

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

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719446400000",
    "number": "1851738736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "266 HARRISTOWN RD",
            "address_2": "SUITE 102",
            "city": "GLEN ROCK",
            "state": "NJ",
            "postal_code": "074523302",
            "telephone_number": "201-652-0400",
            "fax_number": "201-447-5762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "266 HARRISTOWN RD",
            "address_2": "SUITE 102",
            "city": "GLEN ROCK",
            "state": "NJ",
            "postal_code": "074523302",
            "telephone_number": "201-652-0400",
            "fax_number": "201-447-5762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REJUVENATE DENTAL SLEEP MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-31",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A",
        "authorized_official_last_name": "MODESTO-GARRIDO",
        "authorized_official_first_name": "MAYRA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "201-652-0400",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI01825500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maralynn Radin, OPTICIAN
• Raluca Radulescu-Marino, M.D.
• Julian Rapaport, PH.D.
• Reed Next, Inc.
• Reed Next, Inc.
• Reliant Forensic Services
• Marina Revich-Kravzov, M.S. OTR/L
• Danielle Richardson
• Ridgewood Oral Surgery Center LLC
• Ridgewood Valley Dentistry LLC (Ridgewood Valley Pediatric Dentistry)

• General Practice Dentistry in Glen Rock, NJ
• Providers in Glen Rock, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.