Robert Branca, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

040425 Issued in NY

Practice address

112 Alexander Ave
Suite a
Lake Grove, NY 11755-0429

Phone

(631) 265-6655

Fax

(631) 265-9735

NPI assigned

Oct 16, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1129420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427932800000",
    "number": "1003805748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 ALEXANDER AVE",
            "address_2": "SUITE A",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117550429",
            "telephone_number": "631-265-6655",
            "fax_number": "631-265-9735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 ALEXANDER AVE",
            "address_2": "SUITE A",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117550429",
            "telephone_number": "631-265-6655",
            "fax_number": "631-265-9735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANCA",
        "first_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-16",
        "last_updated": "2015-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "040425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIC #",
            "identifier": "040425",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacques S. J. Blanchard, D.P.T.,
• Marcia Blatt, MA
• Robert Joseph Boswell, MD
• Mario Brajuha, LMSW
• Edward M Bram, D.M.D.
• Dawn P Brauer, M.S.P.T., C.I.M.I.
• Andrew Zotos Breslin, LMSW
• Brian K. Berliner, O.D., P.C.
• Patricia J Brims, PA-C
• Alicja Bugnacka, RN

• General Practice Dentistry in Lake Grove, NY
• Providers in Lake Grove, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.