Active NPI
Jedidiah L.G. Janisse, DMD
- Dentist
- Lebanon, NH
National Provider Identifier
1912102849
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 03932
- Practice address
- 367 Route 120
Lebanon, NH 03766-1430 - Phone
- (973) 296-5022
- NPI assigned
- Jun 20, 2007
- Last updated
- Mar 9, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 | 03932 | NH | Primary |
| General Practice Dentistry | 1223G0001X | 016-0002247 | VT |
Addresses
Primary practice location
367 Route 120
Lebanon, NH 03766-1430
Mailing address
367 Route 120
Lebanon, NH 03766-1430
Phone (973) 296-5022
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03932 | NH | MD | Dentist |
| 016-0002247 | VT | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1425859200000",
"number": "1912102849",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "367 ROUTE 120",
"city": "LEBANON",
"state": "NH",
"postal_code": "037661430",
"telephone_number": "973-296-5022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "367 ROUTE 120",
"city": "LEBANON",
"state": "NH",
"postal_code": "037661430",
"telephone_number": "973-296-5022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JANISSE",
"first_name": "JEDIDIAH",
"middle_name": "L.G.",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-20",
"last_updated": "2015-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NH",
"license": "03932",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "VT",
"license": "016-0002247",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.