Active NPI
Kevin Bruce Persily, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- West Orange, NJ
National Provider Identifier
1861532053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 22DI01201900
- Practice address
- 412 Pleasant Valley Way
West Orange, NJ 07052 - Phone
- (973) 731-2468
- NPI assigned
- Feb 7, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 12019 | NJ | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 22DI01201900 | NJ | Primary |
Addresses
Primary practice location
412 Pleasant Valley Way
West Orange, NJ 07052
Mailing address
412 Pleasant Valley Way
West Orange, NJ 07052
Phone (973) 731-2468
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 |
|---|---|---|---|
| 12019 | NJ | MD | Dentist |
| 22DI01201900 | NJ | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727308800000",
"number": "1861532053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "412 PLEASANT VALLEY WAY",
"city": "WEST ORANGE",
"state": "NJ",
"postal_code": "07052",
"telephone_number": "973-731-2468",
"fax_number": "973-731-2501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "412 PLEASANT VALLEY WAY",
"city": "WEST ORANGE",
"state": "NJ",
"postal_code": "07052",
"telephone_number": "973-731-2468"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERSILY",
"first_name": "KEVIN",
"middle_name": "BRUCE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-07",
"last_updated": "2024-09-26",
"certification_date": "2024-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "12019",
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NJ",
"license": "22DI01201900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Orange, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.