Juan Jose Pesantes, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

046461 Issued in NY

Practice address

4104 102ND St
2ND Floor
Corona, NY 11368-2480

Phone

(718) 651-3939

Fax

(718) 651-0159

NPI assigned

Mar 6, 2008

Last updated

Feb 1, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1204761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454284800000",
    "number": "1225208101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11109 JAMAICA AVE",
            "city": "RICHMOND HILL",
            "state": "NY",
            "postal_code": "114182323",
            "telephone_number": "718-580-1011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4104 102ND ST",
            "address_2": "2ND FLOOR",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113682480",
            "telephone_number": "718-651-3939",
            "fax_number": "718-651-0159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PESANTES",
        "first_name": "JUAN",
        "middle_name": "JOSE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-06",
        "last_updated": "2016-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "046461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01738614",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maribel Perez-Santos, LMSW
• Joebelle Fiel Perez, LPN
• Priscyla Yarely Perez, LPN
• Salvador O Perez, MD
• Destiny Perkins
• Physioterra PT PC
• Picasso Dental Office PC
• Marisel Pichardo
• Ebony Denise Pierre, LPN
• Louis Anthony Pisani, R.PH

• General Practice Dentistry in Corona, NY
• Providers in Corona, 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 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.