NPIMap

Organization Active NPI

Modern E Dental

  • General Practice Dentistry
  • Little Neck, NY
National Provider Identifier
1104090471
Registry record updated Apr 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
049968 Issued in NY
Legal business name
MODERN E DENTAL
Practice address
4823 Little Neck Pkwy
Little Neck, NY 11362-1432
Phone
(718) 281-1282
NPI assigned
Apr 17, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2008

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

Authorized official

Name
Dr. Grace E Shin, D.D.SNPI 1295724565
Title
Dentist
Phone
(718) 281-1282

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)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 049968 NY Primary

Addresses

Primary practice location

4823 Little Neck Pkwy
Little Neck, NY 11362-1432

Mailing address

4823 Little Neck Pkwy
Little Neck, NY 11362-1432
Phone (718) 281-1282

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1208390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208390400000",
    "number": "1104090471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4823 LITTLE NECK PKWY",
            "city": "LITTLE NECK",
            "state": "NY",
            "postal_code": "113621432",
            "telephone_number": "718-281-1282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4823 LITTLE NECK PKWY",
            "city": "LITTLE NECK",
            "state": "NY",
            "postal_code": "113621432",
            "telephone_number": "718-281-1282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN E DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-17",
        "last_updated": "2008-04-17",
        "status": "A",
        "authorized_official_last_name": "SHIN",
        "authorized_official_first_name": "GRACE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "718-281-1282",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "049968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Neck, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 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.