Active NPI
Aaa Uptown Star Dental PC
- General Practice Dentistry
- New York, NY
National Provider Identifier
1003958398
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 046105
- Legal business name
- AAA UPTOWN STAR DENTAL PC
- Practice address
- 680 W 204TH St Apt 1C
New York, NY 10034-3003 - Phone
- (212) 569-4652
- Fax
- (212) 569-4644
- NPI assigned
- Feb 13, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Valentina Krivosheyeva, DDS
- Title
- Vice President
- Phone
- (212) 569-4652
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 046105 | NY | Primary |
Addresses
Primary practice location
680 W 204TH St Apt 1C
New York, NY 10034-3003
Mailing address
680 W 204TH St Apt 1C
New York, NY 10034-3003
Phone (212) 569-4652
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01995757 | Medicaid | NY |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- General Practice Dentistry
- New York, NY
- NPI 1689729634
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1003958398",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "680 W 204TH ST APT 1C",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100343003",
"telephone_number": "212-569-4652",
"fax_number": "212-569-4644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "680 W 204TH ST APT 1C",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100343003",
"telephone_number": "212-569-4652",
"fax_number": "212-569-4644"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AAA UPTOWN STAR DENTAL PC",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-13",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "KRIVOSHEYEVA",
"authorized_official_first_name": "VALENTINA",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "212-569-4652",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "046105",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01995757",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.