125TH St. Dental Group, PLLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

051019 Issued in NY

Legal business name

125TH ST. DENTAL GROUP, PLLC

Doing business as

125 St. Braces

Practice address

63 W 125TH St
2ND Floor
New York, NY 10027-4512

Phone

(646) 505-8852

NPI assigned

Jul 19, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Daniel Kuncio, DDS

Title

Member

Phone

(646) 505-8852

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• 125 St. Braces Doing business as

Locations

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

{
    "created_epoch": "1374192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374192000000",
    "number": "1134561137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 W 125TH ST",
            "address_2": "2ND FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100274512",
            "telephone_number": "646-505-8852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 W 125TH ST",
            "address_2": "2ND FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100274512",
            "telephone_number": "646-505-8852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "125TH ST. DENTAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-19",
        "last_updated": "2013-07-19",
        "status": "A",
        "authorized_official_last_name": "KUNCIO",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "646-505-8852",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NY",
            "license": "051019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03047216",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03422386",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01644504",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "125 St. Braces",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in New York, NY
• Providers in New York, NY by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2013; 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.