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Active NPI 1063542587 Individual Practitioner Female Practitioner

Dr. Khadijah Ismael , DMD

Dentist - General Practice • Newark, NJ

Public Directory Information & Medical Disclaimer

This profile is compiled from official public domain records provided by CMS and the NPPES registry. TRUE-MEDINFO is an independent reference directory and does not provide medical advice, diagnosis, or treatment recommendations. Always consult a licensed medical professional for personal health decisions.

Professional Overview & Biography Verified Profile Summary

Dr. Khadijah Ismael, DMD is a registered healthcare professional specializing in Dentist - General Practice in Newark, NJ. Official NPI practice address is registered at 21 QUITMAN ST.

Practice Location & Contact Primary Location

Practice Address

21 Quitman St

Newark, NJ 071034105

Telephone 9734244329
Fax 9738242097
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Newark, NJ

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 28.1 Yrs
Regional Practice Density
85 Specialists

Practicing in Newark, NJ (4316 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License NJ 22DI02314800

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
0097845 (NJ)
Medicaid State Provider ID
0097829 (NJ)
Medicaid State Provider ID
0097837 (NJ)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners
NPI 1740205434

Doctor of Dental Medicine

Dr. Moshe Rose , MD

Psychiatry & Neurology - Psychiatry

NPI 1982765574

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active July 09, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 09, 2007

Registered at 21 QUITMAN ST, NEWARK, NJ 071034105 (Tel: 9734244329)

📍
Updated Business Mailing Address July 09, 2007

Registered at 103 BORMAN AVE, AVENEL, NJ 070012106 (Tel: 9739796144)

👤
Provider Name / Credentials Updated July 09, 2007

Recorded as KHADIJAH ISMAEL, DMD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 09, 2007

Dentist (License #22DI02314800 in NJ)

🟢
Initial NPI Registration & Enumeration March 06, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1063542587
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 06, 2007
Last Update: July 09, 2007
Sole Proprietor: No

Mailing Address

103 Borman Ave

Avenel, NJ 070012106

Phone: 9739796144

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.