Organization Active NPI

Your Smile Dental of Hauppauge

  • Dentist
  • Hauppauge, NY
National Provider Identifier
1053827782
Registry record updated Oct 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
YOUR SMILE DENTAL OF HAUPPAUGE
Practice address
521 Route 111 Ste 106
Hauppauge, NY 11788-4358
Phone
(631) 361-6605
NPI assigned
Dec 18, 2017
Last updated
Oct 1, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2018

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

Authorized official

Name
Lisa Sandman
Title
Office Manager
Phone
(631) 413-2912

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

521 Route 111 Ste 106
Hauppauge, NY 11788-4358

Mailing address

521 Route 111 Ste 106
Hauppauge, NY 11788-4358
Phone (631) 361-6605

Other identifiers 1

IdentifierTypeStateIssuer
03269418MedicaidNY

National Provider Directory

National Provider Directory

Locations

521 Route 111
Ste 106
Hauppauge, NY 11788
Phone (631) 361-6605

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": "1513555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538352000000",
    "number": "1053827782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 ROUTE 111 STE 106",
            "city": "HAUPPAUGE",
            "state": "NY",
            "postal_code": "117884358",
            "telephone_number": "631-361-6605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 ROUTE 111 STE 106",
            "city": "HAUPPAUGE",
            "state": "NY",
            "postal_code": "117884358",
            "telephone_number": "631-361-6605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUR SMILE DENTAL OF HAUPPAUGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-18",
        "last_updated": "2018-10-01",
        "status": "A",
        "authorized_official_last_name": "SANDMAN",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "631-413-2912"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03269418",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hauppauge, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2018; 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.