Active NPI
Executive Dental Care PC
- Preferred Provider Organization
- Brooklyn, NY
National Provider Identifier
1073788717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Preferred Provider Organization
- License
- 036639
- Legal business name
- EXECUTIVE DENTAL CARE PC
- Practice address
- 8011 Fifth Avenue
2ND Floor
Brooklyn, NY 11209 - Phone
- (718) 748-6847
- NPI assigned
- Apr 24, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. James M Wallett, D.D.S.
- Title
- General Dentist/Owner
- Phone
- (718) 748-6847
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Preferred Provider Organization | 305R00000X | 036639 | NY | Primary |
Addresses
Primary practice location
8011 Fifth Avenue
2ND Floor
Brooklyn, NY 11209
Mailing address
8011 Fifth Avenue
2ND Floor
Brooklyn, NY 11209
Phone (718) 748-6847
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00759435 | Medicaid | NY |
National Provider Directory
National Provider Directory- Tax ID family
- Executive Dental Care PC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Dentist
- Brooklyn, NY
- NPI 1700071602
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- General Practice Dentistry
- Brooklyn, NY
- NPI 1528233269
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208995200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1208995200000",
"number": "1073788717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8011 FIFTH AVENUE",
"address_2": "2ND FLOOR",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "11209",
"telephone_number": "718-748-6847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8011 FIFTH AVENUE",
"address_2": "2ND FLOOR",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "11209",
"telephone_number": "718-748-6847"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EXECUTIVE DENTAL CARE PC",
"organizational_subpart": "NO",
"enumeration_date": "2008-04-24",
"last_updated": "2008-04-24",
"status": "A",
"authorized_official_last_name": "WALLETT",
"authorized_official_first_name": "JAMES",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "GENERAL DENTIST/OWNER",
"authorized_official_telephone_number": "718-748-6847",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "D.D.S."
},
"taxonomies": [
{
"code": "305R00000X",
"taxonomy_group": "",
"desc": "Preferred Provider Organization",
"state": "NY",
"license": "036639",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00759435",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 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.