Exceldent of Orange Sullivan

Primary specialty

DentistTaxonomy code 122300000X

License

041682-1 Issued in NY

Legal business name

EXCELDENT OF ORANGE SULLIVAN

Practice address

523 Broadway
Monticello, NY 12701

Phone

(845) 794-0706

Fax

(845) 794-0606

NPI assigned

Apr 7, 2009

Organization subpart

No

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

Authorized official

Name

Mrs. Lori Rivas

Title

Office Manager

Phone

(845) 794-0706

Specialties & licenses 5

Addresses

Tax ID family

Dental Arts Associates2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Exceldent of Orange/Sullivan, LLP

  • Dentist
  • Middletown, NY
  • NPI 1265593420
  NPD tax ID

Locations

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

{
    "created_epoch": "1239062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239062400000",
    "number": "1205079282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 BROADWAY",
            "city": "MONTICELLO",
            "state": "NY",
            "postal_code": "127011111",
            "telephone_number": "845-794-0706",
            "fax_number": "845-794-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "523 BROADWAY",
            "city": "MONTICELLO",
            "state": "NY",
            "postal_code": "12701",
            "telephone_number": "845-794-0706",
            "fax_number": "845-794-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELDENT OF ORANGE SULLIVAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-07",
        "last_updated": "2009-04-07",
        "status": "A",
        "authorized_official_last_name": "RIVAS",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "845-794-0706",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "041682-1",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "050306",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "054091",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "044624-1",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "026906",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Monticello, NY
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2009; 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.