Active NPI
Grace A. O'Connor, D.D.S.
- Dentist
- Bayside, NY
National Provider Identifier
1114936028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 052224-1
- Practice address
- 3912 215TH St
Bayside, NY 11361-2130 - Phone
- (718) 225-2121
- NPI assigned
- Aug 7, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 052224-1 | NY | Primary |
Addresses
Primary practice location
3912 215TH St
Bayside, NY 11361-2130
Mailing address
3912 215TH St
Bayside, NY 11361-2130
Phone (718) 225-2121
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 052224-1 | Other | NY | LICENSES |
| 113465690 | Other | NY | TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 052224-1 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597363200000",
"number": "1114936028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3912 215TH ST",
"city": "BAYSIDE",
"state": "NY",
"postal_code": "113612130",
"telephone_number": "718-225-2121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3912 215TH ST",
"city": "BAYSIDE",
"state": "NY",
"postal_code": "113612130",
"telephone_number": "718-225-2121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'CONNOR",
"first_name": "GRACE",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-07",
"last_updated": "2020-08-14",
"certification_date": "2020-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "052224-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSES",
"identifier": "052224-1",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "113465690",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bayside, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.