Individual provider Active NPI

Samuel C. Mann, DDS

  • Dentist
  • Holtsville, NY
National Provider Identifier
1205053923
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
035230 Issued in NY
Practice address
608 Blue Point Rd
Holtsville, NY 11742-1835
Phone
(631) 475-6517
NPI assigned
Apr 20, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 035230 NY Primary

Addresses

Primary practice location

608 Blue Point Rd
Holtsville, NY 11742-1835

Mailing address

608 Blue Point Rd
Holtsville, NY 11742-1835
Phone (631) 475-6517

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150914001361 NY Order and Referring Only - DentistPractitioner - Dentist 4981911617

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
035230NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
S. C. Mann DDS Dentist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205053923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 BLUE POINT RD",
            "city": "HOLTSVILLE",
            "state": "NY",
            "postal_code": "117421835",
            "telephone_number": "631-475-6517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 BLUE POINT RD",
            "city": "HOLTSVILLE",
            "state": "NY",
            "postal_code": "117421835",
            "telephone_number": "631-475-6517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANN",
        "first_name": "SAMUEL",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "035230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holtsville, NY

Sources for this page

Verify at the official NPI Registry.