Individual provider Active NPI

David B. Ettinger, M.D. D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Newark, DE
National Provider Identifier
1982625547
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
G1-0001099 Issued in DE
Practice address
131 E Chestnut Hill Rd
Newark, DE 19713-4043
Phone
(302) 369-1000
Fax
(302) 369-6016
NPI assigned
Jul 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X G1-0001099 DE Primary
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X C1-0005329 DE

Addresses

Primary practice location

131 E Chestnut Hill Rd
Newark, DE 19713-4043

Mailing address

131 E Chestnut Hill Rd
Newark, DE 19713-4043
Phone (302) 369-1000

Other identifiers 6

IdentifierTypeStateIssuer
510214XMDOtherBC/BS
1000033783MedicaidDE
0000939002MedicaidDE
268440OtherOPTIMUM CHOICE
2940OtherPRINCIPLE/COVENTRY
P10315OtherMIDATLANTIC

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
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G1-0001099DEMDOral and Maxillofacial Surgery (Dentist)
C1-0005329DEMDOral & Maxillofacial Surgery (D.M.D.)

Practice roles

OrganizationSpecialtyStatusNew patients
Jordan Fried DMD LLC Oral and Maxillofacial Surgery PastSince Feb 1, 2020 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": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1982625547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 E CHESTNUT HILL RD",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197134043",
            "telephone_number": "302-369-1000",
            "fax_number": "302-369-6016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 E CHESTNUT HILL RD",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197134043",
            "telephone_number": "302-369-1000",
            "fax_number": "302-369-6016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTINGER",
        "first_name": "DAVID",
        "middle_name": "B.",
        "name_prefix": "Dr.",
        "credential": "M.D.  D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "DE",
            "license": "G1-0001099",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "DE",
            "license": "C1-0005329",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "510214XMD",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000033783",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000939002",
            "state": "DE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMUM CHOICE",
            "identifier": "268440",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRINCIPLE/COVENTRY",
            "identifier": "2940",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDATLANTIC",
            "identifier": "P10315",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.