Complete Dental PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

044278 Issued in NY

Legal business name

COMPLETE DENTAL PC

Practice address

362 W Old Country Rd
Hicksville, NY 11801-4113

Phone

(516) 933-3000

Fax

(516) 933-3001

NPI assigned

Apr 1, 2008

Organization subpart

No

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

Authorized official

Name

Bertha Dina BravoNPI 1124155353

Title

Dentist

Phone

(516) 933-3000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bertha D. Bravo Dentist PC Other name

Practitioners 1

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

• Bertha Dina Bravo, DDS

  • General Practice Dentistry
  • Hempstead, NY
  • NPI 1124155353
  NPD Authorized official

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

{
    "created_epoch": "1207008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612310400000",
    "number": "1184896912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "362 W OLD COUNTRY RD",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118014113",
            "telephone_number": "516-933-3000",
            "fax_number": "516-485-8386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "362 W OLD COUNTRY RD",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118014113",
            "telephone_number": "516-933-3000",
            "fax_number": "516-933-3001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-01",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A",
        "authorized_official_last_name": "BRAVO",
        "authorized_official_first_name": "BERTHA",
        "authorized_official_middle_name": "DINA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "516-933-3000"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "044278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01353584",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bertha D. Bravo Dentist PC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Bertha D. Bravo Dentist PC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• General Practice Dentistry in Hicksville, NY
• Providers in Hicksville, 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 Feb 3, 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.