NPIMap

Organization Active NPI

Comprehensive Pediatric Dentistry

  • Pediatric Dentistry
  • Bound Brook, NJ
National Provider Identifier
1043441876
Registry record updated Jul 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DI15948 Issued in NJ
Legal business name
COMPREHENSIVE PEDIATRIC DENTISTRY
Practice address
111 E Union Ave
Bound Brook, NJ 08805-1761
Phone
(732) 356-1830
NPI assigned
Jul 28, 2009
Last updated
Jul 28, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2009

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

Authorized official

Name
Dr. Yasmi O Crystal, DMDNPI 1215957014
Title
Owner
Phone
(732) 356-1830

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
Pediatric Dentistry 1223P0221X DI15948 NJ Primary

Addresses

Primary practice location

111 E Union Ave
Bound Brook, NJ 08805-1761

Mailing address

111 E Union Ave
Bound Brook, NJ 08805-1761
Phone (732) 356-1830

Other identifiers 1

IdentifierTypeStateIssuer
0188395MedicaidNJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1248739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248739200000",
    "number": "1043441876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E UNION AVE",
            "city": "BOUND BROOK",
            "state": "NJ",
            "postal_code": "088051761",
            "telephone_number": "732-356-1830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E UNION AVE",
            "city": "BOUND BROOK",
            "state": "NJ",
            "postal_code": "088051761",
            "telephone_number": "732-356-1830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-28",
        "last_updated": "2009-07-28",
        "status": "A",
        "authorized_official_last_name": "CRYSTAL",
        "authorized_official_first_name": "YASMI",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-356-1830",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "DI15948",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0188395",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bound Brook, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2009; 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.