NPIMap

Organization Active NPI

Staten Island Pediatric Dentistry

  • Pediatric Dentistry
  • Staten Island, NY
National Provider Identifier
1053509687
Registry record updated Oct 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
0425291 Issued in NY
Legal business name
STATEN ISLAND PEDIATRIC DENTISTRY
Practice address
195 Bridgetown St
Staten Island, NY 10314-6006
Phone
(718) 761-7316
Fax
(718) 761-0558
NPI assigned
Oct 9, 2007
Last updated
Oct 9, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2007

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

Authorized official

Name
Dr. Deborah Anne Gries, D.M.D.NPI 1316935505
Title
President
Phone
(718) 761-7316

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 0425291 NY Primary

Addresses

Primary practice location

195 Bridgetown St
Staten Island, NY 10314-6006

Mailing address

195 Bridgetown St
Staten Island, NY 10314-6006
Phone (718) 761-7316

National Provider Directory

National Provider Directory

Locations

195 Bridgetown St
Staten Island, NY 10314
Phone (718) 761-7316

Practitioners & affiliated clinicians

Practitioners 5

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": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191888000000",
    "number": "1053509687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 BRIDGETOWN ST",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103146006",
            "telephone_number": "718-761-7316",
            "fax_number": "718-761-0558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 BRIDGETOWN ST",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103146006",
            "telephone_number": "718-761-7316",
            "fax_number": "718-761-0558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATEN ISLAND PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-09",
        "last_updated": "2007-10-09",
        "status": "A",
        "authorized_official_last_name": "GRIES",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-761-7316",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "0425291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; 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.