The Wisdom Tooth of Commack

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

035654 Issued in NY

Legal business name

THE WISDOM TOOTH OF COMMACK

Practice address

6040 Jericho Tpke
Commack, NY 11725-2806

Phone

(631) 462-0300

Fax

(631) 462-0347

NPI assigned

May 15, 2007

Organization subpart

No

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

Authorized official

Name

Michael H Kantrowitz, D.M.D.

Title

Owner

Phone

(631) 462-0300

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210636800000",
    "number": "1073729380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6040 JERICHO TPKE",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117252806",
            "telephone_number": "631-462-0300",
            "fax_number": "631-462-0347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6040 JERICHO TPKE",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117252806",
            "telephone_number": "631-462-0300",
            "fax_number": "631-462-0347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WISDOM TOOTH OF COMMACK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2008-05-13",
        "status": "A",
        "authorized_official_last_name": "KANTROWITZ",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-462-0300",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "035654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; 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.