Mill Road Dental Center PC

Primary specialty

DentistTaxonomy code 122300000X

License

19161 Issued in NJ

Legal business name

MILL ROAD DENTAL CENTER PC

Practice address

5 Mill Road
Irvington, NJ 07111

Phone

(973) 372-7049

Fax

(973) 372-7961

NPI assigned

Dec 27, 2006

Organization subpart

No

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

Authorized official

Name

Yeugeny Audeychik, DDS

Title

Dentist

Phone

(973) 372-7049

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367884800000",
    "number": "1184789125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 MILL ROAD",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "07111",
            "telephone_number": "973-372-7049",
            "fax_number": "973-372-7961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 MILL ROAD",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "07111",
            "telephone_number": "973-372-7049",
            "fax_number": "973-372-7961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILL ROAD DENTAL CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2013-05-07",
        "status": "A",
        "authorized_official_last_name": "AUDEYCHIK",
        "authorized_official_first_name": "YEUGENY",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "973-372-7049",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NJ",
            "license": "19161",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NJ",
            "license": "19119",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "636150101",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 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.