Individual provider Active NPI

Judith Sheilah Mamber, DMD

  • General Practice Dentistry
  • Woodbridge, CT
National Provider Identifier
1912938895
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6624 Issued in CT
Practice address
23 Tulip Tree LN
Woodbridge, CT 06525-1414
Phone
(203) 387-4023
NPI assigned
Jul 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 6624 CT Primary

Addresses

Primary practice location

23 Tulip Tree LN
Woodbridge, CT 06525-1414

Mailing address

130 E Main St
Meriden, CT 06450-5604
Phone (203) 237-4519

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150715001312 CT Order and Referring Only - DentistPractitioner - Dentist 9032422316

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6624CTMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912938895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 E MAIN ST",
            "city": "MERIDEN",
            "state": "CT",
            "postal_code": "064505604",
            "telephone_number": "203-237-4519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 TULIP TREE LN",
            "city": "WOODBRIDGE",
            "state": "CT",
            "postal_code": "065251414",
            "telephone_number": "203-387-4023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMBER",
        "first_name": "JUDITH",
        "middle_name": "SHEILAH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "6624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, CT

Sources for this page

Verify at the official NPI Registry.