Excel Dentistry, P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI01825501 Issued in NJ

Legal business name

EXCEL DENTISTRY, P.C.

Practice address

266 Harristown Rd
Suite 102
Glen Rock, NJ 07452-3302

Phone

(201) 652-0400

Fax

(201) 447-5762

NPI assigned

Dec 15, 2006

Organization subpart

No

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

Authorized official

Name

Mayra Modesto-Garrido, D.D.S.NPI 1568524528

Title

Dentist

Phone

(201) 652-0400

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mayra Modesto-Garrido, D.D.S.

  • General Practice Dentistry
  • Glen Rock, NJ
  • NPI 1568524528
  NPD (past) Authorized official
• Aryam Modesto, D.M.D.

  • Dentist
  • Glen Rock, NJ
  • NPI 1891066486
  NPD (past)

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423699200000",
    "number": "1982766853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "266 HARRISTOWN RD",
            "address_2": "SUITE 102",
            "city": "GLEN ROCK",
            "state": "NJ",
            "postal_code": "074523302",
            "telephone_number": "201-652-0400",
            "fax_number": "201-447-5762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "266 HARRISTOWN RD",
            "address_2": "SUITE 102",
            "city": "GLEN ROCK",
            "state": "NJ",
            "postal_code": "074523302",
            "telephone_number": "201-652-0400",
            "fax_number": "201-447-5762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEL DENTISTRY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2015-02-12",
        "status": "A",
        "authorized_official_last_name": "MODESTO-GARRIDO",
        "authorized_official_first_name": "MAYRA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "201-652-0400",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI01825501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6037704",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "898217",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0066028",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Glen Rock, NJ
• Providers in Glen Rock, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 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.

Verify at the official NPI Registry.