Active NPI
Usha Polavarapu, DDS
- Dentist
- Irvington, NJ
National Provider Identifier
1891822482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 19126
- Practice address
- 1152 Clinton Avenue
Irvington, NJ 07111 - Phone
- (973) 372-5640
- Fax
- (973) 371-7697
- NPI assigned
- Feb 28, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 19126 | NJ | Primary |
Addresses
Primary practice location
1152 Clinton Avenue
Irvington, NJ 07111
Mailing address
1152 Clinton Avenue
Irvington, NJ 07111
Phone (973) 372-5640
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7421109 | Medicaid | NJ |
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 |
|---|---|---|---|
| 19126 | NJ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Smile Dental Office, P.C. | Dentist | Past | 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 and National Provider Directory roles.
-
- Dentist
- Irvington, NJ
- NPI 1093910143
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329264000000",
"number": "1891822482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1152 CLINTON AVENUE",
"city": "IRVINGTON",
"state": "NJ",
"postal_code": "07111",
"telephone_number": "973-372-5640",
"fax_number": "973-371-7697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1152 CLINTON AVENUE",
"city": "IRVINGTON",
"state": "NJ",
"postal_code": "07111",
"telephone_number": "973-372-5640",
"fax_number": "973-371-7697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLAVARAPU",
"first_name": "USHA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-28",
"last_updated": "2012-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "19126",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7421109",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Irvington, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.