Carol Onyango Middernacht, D.M.D

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

054605 Issued in NY

Practice address

713 Pierce Rd
Clifton Park, NY 12065-1302

Phone

(518) 373-1181

NPI assigned

Oct 5, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• McDonnell and McMahon Pediatric Dentistry PLLC

  dba The Smile Lodge

  • Pediatric Dentistry
  • Clifton Park, NY
  • NPI 1821486754
  NPD (past)

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

{
    "created_epoch": "1223164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669939200000",
    "number": "1114178415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 STONE CREST DR",
            "city": "MECHANICVILLE",
            "state": "NY",
            "postal_code": "121183657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "713 PIERCE RD",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120651302",
            "telephone_number": "518-373-1181"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "722 W 168th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100323727",
            "country_code": "US",
            "telephone_number": "212-305-6754",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIDDERNACHT",
        "first_name": "CAROL",
        "middle_name": "ONYANGO",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-05",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "054605",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "P57128",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benny Maria Mendez-Osorio, DDS
• Eric Devaney Mercadante, LMSW
• Michael D. Wood, PT, PC (Clifton Park Physical Therapy)
• Michael Dudick
• David Michalowski, RPH
• Carrie Anne Nancy Milham, LCSW-R
• Diane Scavullo Miller, CCC
• Donna M Miller, PTA
• Harry S Miller, M.D.
• Jennifer Earle Miller, M.D.

• Pediatric Dentistry in Clifton Park, NY
• Providers in Clifton Park, NY by specialty
• Pediatric Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; 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.