Village Dental Group of Central Square

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

40049 Issued in NY

Legal business name

VILLAGE DENTAL GROUP OF CENTRAL SQUARE

Practice address

537 S Main St
Central Square, NY 13036-3500

Phone

(315) 676-3001

Fax

(315) 676-3785

NPI assigned

Mar 6, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Sandra M. Anderson

Title

Office Manager

Phone

(315) 676-3001

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093845430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 369",
            "city": "CENTRAL SQUARE",
            "state": "NY",
            "postal_code": "130360369",
            "telephone_number": "315-676-3001",
            "fax_number": "315-676-3785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "537 S MAIN ST",
            "city": "CENTRAL SQUARE",
            "state": "NY",
            "postal_code": "130363500",
            "telephone_number": "315-676-3001",
            "fax_number": "315-676-3785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE DENTAL GROUP OF CENTRAL SQUARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "315-676-3001",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "40049",
            "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 Aug 22, 2020; 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.