Active NPI
Jose Rafael Perez-Irizarry, D.M.D
- General Practice Dentistry
- Riverdale, GA
National Provider Identifier
1902900491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12118
- Practice address
- 207 Upper Riverdale Rd SW
Riverdale, GA 30274-2585 - Phone
- (678) 628-4626
- NPI assigned
- Sep 12, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12118 | GA | Primary |
Addresses
Primary practice location
207 Upper Riverdale Rd SW
Riverdale, GA 30274-2585
Mailing address
207 Upper Riverdale Rd SW
Riverdale, GA 30274-2585
Phone (678) 628-4626
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 |
|---|---|---|---|
| 12118 | GA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Enw Dentistry PC Dba | General Practice | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485388800000",
"number": "1902900491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "207 UPPER RIVERDALE RD SW",
"city": "RIVERDALE",
"state": "GA",
"postal_code": "302742585",
"telephone_number": "678-628-4626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "207 UPPER RIVERDALE RD SW",
"city": "RIVERDALE",
"state": "GA",
"postal_code": "302742585",
"telephone_number": "678-628-4626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ-IRIZARRY",
"first_name": "JOSE",
"middle_name": "RAFAEL",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-12",
"last_updated": "2017-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "12118",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverdale, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.