Individual provider Active NPI

Elise Gayoso Penafiel, D.D.S.

  • General Practice Dentistry
  • Glen Burnie, MD
National Provider Identifier
1962554824
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12745 Issued in MD
Practice address
7425 Baltimore Annapolis Blvd
Glen Burnie, MD 21061-3507
Phone
(410) 760-5120
Fax
(410) 760-9470
NPI assigned
Jan 18, 2007
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 12745 MD Primary

Addresses

Primary practice location

7425 Baltimore Annapolis Blvd
Glen Burnie, MD 21061-3507

Mailing address

1173 Gumbottom Rd
Crownsville, MD 21032-1517
Phone (410) 987-0785

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20150806009743 MD Order and Referring Only - DentistPractitioner - Dentist 5698089597

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Lifetime Dental Care of Maryland, Badger, P.C. 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962554824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1173 GUMBOTTOM RD",
            "city": "CROWNSVILLE",
            "state": "MD",
            "postal_code": "210321517",
            "telephone_number": "410-987-0785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7425 BALTIMORE ANNAPOLIS BLVD",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210613507",
            "telephone_number": "410-760-5120",
            "fax_number": "410-760-9470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENAFIEL",
        "first_name": "ELISE",
        "middle_name": "GAYOSO",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "12745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Burnie, MD

Sources for this page

Verify at the official NPI Registry.