Organization Active NPI

Aaa Uptown Star Dental PC

  • General Practice Dentistry
  • New York, NY
National Provider Identifier
1003958398
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
046105 Issued in NY
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

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Valentina Krivosheyeva, DDSNPI 1689729634
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)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 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

IdentifierTypeStateIssuer
01995757MedicaidNY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

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.

Verify at the official NPI Registry.