NPIMap

Organization Active NPI

Cicero Dental Associates

  • General Practice Dentistry
  • Cicero, NY
National Provider Identifier
1053478743
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
031849-1 Issued in NY
Legal business name
CICERO DENTAL ASSOCIATES
Practice address
7770 Frontage Rd
Cicero, NY 13039-8600
Phone
(315) 458-3088
Fax
(315) 458-5682
NPI assigned
Jan 2, 2007
Last updated
Aug 22, 2020By the provider in NPPES
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. Michael Botty, DDS
Title
Owner
Phone
(315) 458-3088

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 031849-1 NY Primary

Addresses

Primary practice location

7770 Frontage Rd
Cicero, NY 13039-8600

Mailing address

7770 Frontage Rd
Cicero, NY 13039-8600
Phone (315) 458-3088

Other identifiers 7

IdentifierTypeStateIssuer
00764723MedicaidNY
02587548MedicaidNY
02608079MedicaidNY
02783686MedicaidNY
02134018MedicaidNY
02783746MedicaidNY
00461138MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Cicero Dental Associates2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7770 Frontage Rd
Cicero, NY 13039
Phone (315) 458-3088

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 4

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": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053478743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7770 FRONTAGE RD",
            "city": "CICERO",
            "state": "NY",
            "postal_code": "130398600",
            "telephone_number": "315-458-3088",
            "fax_number": "315-458-5682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7770 FRONTAGE RD",
            "city": "CICERO",
            "state": "NY",
            "postal_code": "130398600",
            "telephone_number": "315-458-3088",
            "fax_number": "315-458-5682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CICERO DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOTTY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-458-3088",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "031849-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00764723",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02587548",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02608079",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02783686",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02134018",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02783746",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00461138",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cicero, 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.