Active NPI
Antonious Atef Dimyan, DDS
- Dentist
- Lincroft, NJ
National Provider Identifier
1063144491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 22DI02902400
- Practice address
- 9 Middletown Lincroft Rd
Lincroft, NJ 07738-1511 - Phone
- (732) 842-5005
- NPI assigned
- Jun 24, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22DI02902400 | NJ | Primary |
Addresses
Primary practice location
9 Middletown Lincroft Rd
Lincroft, NJ 07738-1511
Mailing address
14627 Reeves Ave
Flushing, NY 11367-1220
Phone (917) 569-7070
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI02902400 | NJ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sunshine Dental, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Lincroft, NJ
- NPI 1265722490
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1656028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656028800000",
"number": "1063144491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14627 REEVES AVE",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113671220",
"telephone_number": "917-569-7070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9 MIDDLETOWN LINCROFT RD",
"city": "LINCROFT",
"state": "NJ",
"postal_code": "077381511",
"telephone_number": "732-842-5005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIMYAN",
"first_name": "ANTONIOUS",
"middle_name": "ATEF",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-06-24",
"last_updated": "2022-06-24",
"certification_date": "2022-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "22DI02902400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lincroft, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.