Alexander J Antonakos, D.D.S.
Individual provider Active NPI Dentist · Wethersfield, CT
NPI 1053304162 · NPPES record last updated Feb 17, 2025
Key facts
- NPI
- 1053304162
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 040301-01 (NY)
- Practice address
- 23 Garden St
Wethersfield, CT 06109-3118 - Phone
- (860) 529-0170
- NPI assigned
- Aug 24, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Dentist
- Education
- New York University College of Dentistry, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
13750 Jamaica Ave
Jamaica, NY 11435-3610
2758 Middle Country Rd
Lake Grove, NY 11755-2118
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250915000050 | NY | Practitioner - Dentist | 6608175377 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 008437 | CT | MD | Dentist |
| 040301-01 | NY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Damian Family Care Centers, Inc. | Current |
Accepting new patients | |
| Damian Family Care Centers, Inc. | Current |
Accepting new patients |
Locations
8956 162nd St
#3
Jamaica, NY 11432
Phone (718) 297-8000
13750 Jamaica Ave
Jamaica, NY 11435
Phone (718) 298-5100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 008437 | CT | |
| Dentist | 122300000X | 040301-01 | NY | Yes |
Addresses
Primary practice location
23 Garden St
Wethersfield, CT 06109-3118
Mailing address
23 Garden St
Wethersfield, CT 06109-3118
Phone (860) 529-0170
Other providers in Wethersfield, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 17, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.