NPIMap

Organization Active NPI

South Central Dental Implant PLLC

  • Dentist
  • Valley Stream, NY
National Provider Identifier
1144767773
Registry record updated Jan 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
047962 Issued in NY
Legal business name
SOUTH CENTRAL DENTAL IMPLANT PLLC
Practice address
44 S Central Ave
Suite #2
Valley Stream, NY 11580-5432
Phone
(516) 561-7788
NPI assigned
Jan 20, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2017

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

Authorized official

Name
Dr. Michael Yehuda Ivry, DDSNPI 1154509503
Title
Owner
Phone
(516) 561-7788

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 047962 NY Primary

Addresses

Primary practice location

44 S Central Ave
Suite #2
Valley Stream, NY 11580-5432

Mailing address

44 S Central Ave
Suite #2
Valley Stream, NY 11580-5432
Phone (516) 561-7788

National Provider Directory

National Provider Directory

Locations

44 S Central Ave
Ste 2
Valley Stream, NY 11580
Phone (516) 561-7788

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1484870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484870400000",
    "number": "1144767773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 S CENTRAL AVE",
            "address_2": "SUITE #2",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115805432",
            "telephone_number": "516-561-7788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 S CENTRAL AVE",
            "address_2": "SUITE #2",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115805432",
            "telephone_number": "516-561-7788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL DENTAL IMPLANT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-20",
        "last_updated": "2017-01-20",
        "status": "A",
        "authorized_official_last_name": "IVRY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "YEHUDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-561-7788",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "047962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valley Stream, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2017; 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.