Active NPI
Iry Tak, DDS
- Dentist
- Cincinnati, OH
National Provider Identifier
1235590415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 30.025929
- Practice address
- 3333 Burnet Ave
Cincinnati, OH 45229-3026 - Phone
- (513) 636-4641
- Fax
- (513) 636-8283
- NPI assigned
- Mar 15, 2016
- Last updated
- Jun 9, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30.025929 | OH | Primary |
| General Practice Dentistry | 1223G0001X | 059415-1 | NY | |
| Pediatric Dentistry | 1223P0221X | 30.025929 | OH | |
| Student in an Organized Health Care Education/Training Program | 390200000X | NU |
Addresses
Primary practice location
3333 Burnet Ave
Cincinnati, OH 45229-3026
Mailing address
3333 Burnet Ave
Cincinnati, OH 45229-3026
Phone (513) 636-4641
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 059415-1 | NY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fordham Plaza Dental Associates | 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": "1458000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591660800000",
"number": "1235590415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3333 BURNET AVE",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452293026",
"telephone_number": "513-636-4641",
"fax_number": "513-636-8283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3333 BURNET AVE",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452293026",
"telephone_number": "513-636-4641",
"fax_number": "513-636-8283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAK",
"first_name": "IRY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-03-15",
"last_updated": "2020-06-09",
"certification_date": "2020-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "30.025929",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "059415-1",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "OH",
"license": "30.025929",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cincinnati, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.