3545 Johnson Blvd Dental PC
Organization Active NPI Dental Clinic/Center · Bronx, NY
NPI 1124759527 · NPPES record last updated Aug 28, 2024
Key facts
- NPI
- 1124759527
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dental Clinic/Center 261QD0000X
- Legal business name
- 3545 JOHNSON BLVD DENTAL PC
- Practice address
- 1624 University Ave BSMT
Bronx, NY 10453-6948 - Phone
- (718) 294-3725
- NPI assigned
- Jun 17, 2022
- Organization subpart
- No
Authorized official
- Name
- Alejandro Leonel Williams, DDS
- Title
- Owner
- Phone
- (718) 294-3725
Practitioners 20
-
Carlos Acosta, DDS
-
Juan Pablo Collado, D.D.S.
-
Juan Bautista Espaillat, D.D.S.
-
John Nicholas Finelli, D.D.S.
-
Manuel D Galan Jr., DDS
-
Nancy Mercedes Jimenez, D.D.S.
-
Hanna Hyun Kim, DDS
-
Eva Lebron, DDS
-
Obianuju Okeke, DMD
-
Marina Podlubny, DDS
-
Yandresco Quintana, DDS, MD
-
Jose E Santana, DDS . FCH.
-
Fernando Leon, D.D.S.
-
Christian Santana, DDS
-
Juan J Solano, DDS
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220827000242 | NY | Part B Supplier - Clinic/Group Practice | 4981088762 |
Receives reassigned benefits from 20 practitioners Practice locations: Bronx, NY; New York, NY |
National Provider Directory
Locations
6 E 167th St
Bronx, NY 10452
Phone (718) 588-8685
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | Yes |
Addresses
Primary practice location
1624 University Ave BSMT
Bronx, NY 10453-6948
Mailing address
1624 University Ave BSMT
Bronx, NY 10453-6948
Phone (718) 294-3725
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06804993 | Medicaid | NY |
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All providers in Bronx, NY · Dental Clinic/Center in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.