Organization Active NPI

Afam Family Dental PLLC

  • Dentist
  • Brooklyn, NY
National Provider Identifier
1114324696
Registry record updated Nov 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
054434 Issued in NY
Legal business name
AFAM FAMILY DENTAL PLLC
Practice address
5205 Church Ave
Brooklyn, NY 11203-3513
Phone
(718) 485-4111
NPI assigned
Nov 26, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2014

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

Authorized official

Name
Dr. Robert Fatakhov, DDS
Title
Member
Phone
(718) 485-4111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 054434 NY Primary

Addresses

Primary practice location

5205 Church Ave
Brooklyn, NY 11203-3513

Mailing address

5205 Church Ave
Brooklyn, NY 11203-3513
Phone (718) 485-4111

National Provider Directory

National Provider Directory

Locations

5205 Church Ave
Brooklyn, NY 11203
Phone (718) 342-2500

NPI Registry JSON

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

{
    "created_epoch": "1416960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416960000000",
    "number": "1114324696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5205 CHURCH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112033513",
            "telephone_number": "718-485-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5205 CHURCH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112033513",
            "telephone_number": "718-485-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFAM FAMILY DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-26",
        "last_updated": "2014-11-26",
        "status": "A",
        "authorized_official_last_name": "FATAKHOV",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "718-485-4111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "054434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2014; 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.