Individual provider Active NPI

Lina Vega, D.D.S.

  • General Practice Dentistry
  • Rochester, NY
National Provider Identifier
1114169158
Registry record updated Feb 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
055011-1 Issued in NY
Practice address
625 Elmwood Ave
Eastman Dental Center
Rochester, NY 14620
Phone
(585) 275-5051
NPI assigned
Apr 6, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 055011-1 NY Primary

Addresses

Primary practice location

625 Elmwood Ave
Eastman Dental Center
Rochester, NY 14620

Mailing address

4292 Lake Ave
Rochester, NY 14612-4808
Phone (585) 663-3957

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160225002149 NY Order and Referring Only - DentistPractitioner - Dentist 3476858663

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
055011-1NYMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1238976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676246400000",
    "number": "1114169158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4292 LAKE AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146124808",
            "telephone_number": "585-663-3957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 ELMWOOD AVE",
            "address_2": "EASTMAN DENTAL CENTER",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "14620",
            "telephone_number": "585-275-5051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VEGA",
        "first_name": "LINA",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-06",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "055011-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.