My Smiles Dental PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MY SMILES DENTAL PC

Practice address

2101 Bay Ridge Pkwy # C
Brooklyn, NY 11204-5955

Phone

(212) 332-6996

NPI assigned

Sep 30, 2021

Last updated

Sep 30, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Grigoriy Yusupov, MD

Title

Owner

Phone

(718) 232-6996

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1632960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632960000000",
    "number": "1164194874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 BAY RIDGE PKWY # C",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112045955",
            "telephone_number": "212-332-6996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 BAY RIDGE PKWY # C",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112045955",
            "telephone_number": "212-332-6996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY SMILES DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-30",
        "last_updated": "2021-09-30",
        "certification_date": "2021-09-30",
        "status": "A",
        "authorized_official_last_name": "YUSUPOV",
        "authorized_official_first_name": "GRIGORIY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-232-6996",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• My Tech Ortho Inc
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• My1Teacher Corp
• Vadim A Myakshin, M.S. ED.

• General Practice Dentistry in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2021; 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.