Grand Dental Care PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

046215 Issued in NY

Legal business name

GRAND DENTAL CARE PC

Practice address

2000 Grand Ave
North Baldwin, NY 11510-2811

Phone

(516) 378-1968

Fax

(516) 608-9319

NPI assigned

Dec 13, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Flora Angela Chavez-Romero, DDS

Title

President

Phone

(516) 378-1968

Specialties & licenses 3

Addresses

Other identifiers 3

Locations

Practitioners 1

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

• Eyra Ixcolin, RDH

  • Dental Hygienist
  • North Baldwin, NY
  • NPI 1780950154
  NPD (past)

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

{
    "created_epoch": "1323734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332374400000",
    "number": "1053689463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 GRAND AVE",
            "city": "NORTH BALDWIN",
            "state": "NY",
            "postal_code": "115102811",
            "telephone_number": "516-378-1968",
            "fax_number": "516-608-9319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 GRAND AVE",
            "city": "NORTH BALDWIN",
            "state": "NY",
            "postal_code": "115102811",
            "telephone_number": "516-378-1968",
            "fax_number": "516-608-9319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND DENTAL CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-13",
        "last_updated": "2012-03-22",
        "status": "A",
        "authorized_official_last_name": "CHAVEZ-ROMERO",
        "authorized_official_first_name": "FLORA",
        "authorized_official_middle_name": "ANGELA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-378-1968",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "046215",
            "primary": true
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": "NY",
            "license": "052129",
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": "NY",
            "license": "P82633",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02826084",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01588090",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01627467",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather Gibbs
• Nichala Kadene Gibson
• Emeline Gilbert
• Malika Godbolt, CERTIFIED DOULA
• Melanie Gordon, ATC
• Grand Dental, P. C.
• Jacqueline M Gucker, DPT
• Alina Gutkovich, LDO
• Stephanie Guzman, LPN
• Latisha Hancock

• General Practice Dentistry in North Baldwin, NY
• Providers in North Baldwin, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2012; 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.