Pure Dental of Long Island PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PURE DENTAL OF LONG ISLAND PC

Practice address

496 County Road 111
Building F
Manorville, NY 11949

Phone

(631) 929-5855

Fax

(631) 886-1971

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

Ms. Paige Oberman

Title

Insurance Manager

Phone

(631) 663-0955

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Travis James Mackey

  • Dentist
  • Manorville, NY
  • NPI 1760063135
  NPD (past)

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699833600000",
    "number": "1114133345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "496 COUNTY ROAD 111",
            "address_2": "BUILDING F",
            "city": "MANORVILLE",
            "state": "NY",
            "postal_code": "11949",
            "telephone_number": "631-929-5855",
            "fax_number": "631-886-1971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "496 COUNTY ROAD 111",
            "address_2": "BUILDING F",
            "city": "MANORVILLE",
            "state": "NY",
            "postal_code": "11949",
            "telephone_number": "631-929-5855",
            "fax_number": "631-886-1971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURE DENTAL OF LONG ISLAND PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2023-11-13",
        "status": "A",
        "authorized_official_last_name": "OBERMAN",
        "authorized_official_first_name": "PAIGE",
        "authorized_official_title_or_position": "INSURANCE MANAGER",
        "authorized_official_telephone_number": "631-663-0955",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra Peters, CASAC-T, CARC
• Kerri Ann Petitpain
• Karen Diers Piddoubny, LBA
• PLC Optical Corp
• Krystal A Porfidia
• Nancy April Quintilian
• R Lee PT
• Christine E Racca, MS ED, S.D.A.
• Christopher Michael Raeihle, MS OTRL
• Keri L Reilly, SLP

• General Practice Dentistry in Manorville, NY
• Providers in Manorville, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; 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.