Stony Brook Cosmetic Dentistry, P.C.

Primary specialty

DentistTaxonomy code 122300000X

License

034701 Issued in NY

Legal business name

STONY BROOK COSMETIC DENTISTRY, P.C.

Doing business as

Stony Brook General & Cosmetic Dentistry

Practice address

215 Hallock Rd
Suite 2
Stony Brook, NY 11790-3078

Phone

(631) 689-3226

Fax

(631) 689-3155

NPI assigned

Dec 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Keith V Watkins, D.D.S.NPI 1194865246

Title

Owner/Dentist

Phone

(631) 689-3226

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Stony Brook General & Cosmetic Dentistry Doing business as

Practitioners 1

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.

• Keith V Watkins, D.D.S.

  • Dentist
  • Stony Brook, NY
  • NPI 1194865246
  Authorized official Same address or phone

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

{
    "created_epoch": "1198627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198627200000",
    "number": "1083898183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 HALLOCK ROAD",
            "address_2": "SUITE 2",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117903078",
            "telephone_number": "631-689-3226",
            "fax_number": "631-689-3155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 HALLOCK RD",
            "address_2": "SUITE 2",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117903078",
            "telephone_number": "631-689-3226",
            "fax_number": "631-689-3155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONY BROOK COSMETIC DENTISTRY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-26",
        "last_updated": "2007-12-26",
        "status": "A",
        "authorized_official_last_name": "WATKINS",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "631-689-3226",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "034701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02630335",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stony Brook General & Cosmetic Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2007; 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.