Active NPI
Pember Bates Edwards, DDS
- Dentist
- Stony Brook, NY
National Provider Identifier
1144677980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 059727
- Practice address
- Suny at Stony Brook Hospital Dentistry
151 Westchester Hall
Stony Brook, NY 11794-8711 - Phone
- (631) 444-2557
- Fax
- (631) 444-6013
- NPI assigned
- May 23, 2016
- 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 | 059727 | NY | Primary |
Addresses
Primary practice location
Suny at Stony Brook Hospital Dentistry
151 Westchester Hall
Stony Brook, NY 11794-8711
Mailing address
Suny at Stony Brook Hospital Dentistry
151 Westchester Hall
Stony Brook, NY 11794-8711
Phone (631) 444-2557
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 11, 2026 through Feb 11, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 059727 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714521600000",
"number": "1144677980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "SUNY AT STONY BROOK HOSPITAL DENTISTRY",
"address_2": "151 WESTCHESTER HALL",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "117948711",
"telephone_number": "631-444-2557",
"fax_number": "631-444-6013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "SUNY AT STONY BROOK HOSPITAL DENTISTRY",
"address_2": "151 WESTCHESTER HALL",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "117948711",
"telephone_number": "631-444-2557",
"fax_number": "631-444-6013"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "PEMBER",
"middle_name": "BATES",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-23",
"last_updated": "2024-05-01",
"certification_date": "2024-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "059727",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stony Brook, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.