Sanju P. Jose, D.D.S., M.D.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

16308 Issued in MD

Practice address

6395 Dobbin Rd Ste 208
Columbia, MD 21045-4759

Phone

(410) 997-1189

Fax

(410) 992-5474

NPI assigned

Jul 12, 2014

Last updated

Apr 28, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 26, 2017 through Jul 26, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Columbia Center for Implants & Periodontics

  • Periodontics
  • Columbia, MD
  • NPI 1932733896
  NPD
• Peter L Passero DDS & Brian a Feeney DMD PLC

  • Periodontics
  • McLean, VA
  • NPI 1821284431
  NPD (past)

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

{
    "created_epoch": "1405123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588032000000",
    "number": "1932516804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PINE VALLEY DR",
            "city": "IMPERIAL",
            "state": "PA",
            "postal_code": "151269332",
            "telephone_number": "410-913-4760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6395 DOBBIN RD STE 208",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210454759",
            "telephone_number": "410-997-1189",
            "fax_number": "410-992-5474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOSE",
        "first_name": "SANJU",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-12",
        "last_updated": "2020-04-28",
        "certification_date": "2020-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MD",
            "license": "16308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Michele Jordan, COTA/L
• Michael A Jordan, LCSW-C
• Rachel V Jordan, PHD, ATC, LAT, NASM
• Shay Ayn Jordan, RN
• Tykeyha Jordan
• Alicia L Joseph Baker, LCSW-C
• Talia Joseph-Germain
• Darren Joseph, DPT
• Faith Breanna Joseph
• Maria Ann Joseph, PHARMD

• Periodontics in Columbia, MD
• Providers in Columbia, MD by specialty
• Periodontics in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.