Stony Brook Dental Associates

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

031804-1 Issued in NY

Legal business name

STONY BROOK DENTAL ASSOCIATES

Practice address

Sullivan Hall Room 170
Faculty Practice
Stony Brook, NY 11794-8705

Phone

(631) 632-8971

Fax

(631) 632-7658

NPI assigned

Mar 11, 2008

Last updated

Mar 11, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Robert Reiner, D.D.S

Title

Executive Director

Phone

(631) 632-8971

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nora A Odingo, DMD

  • Oral and Maxillofacial Pathology Dentistry
  • Stony Brook, NY
  • NPI 1922218023
  NPD (past)
• Patricia Swanson

  • Prosthodontics
  • Stony Brook, NY
  • NPI 1629456603
  NPD (past)

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

{
    "created_epoch": "1205193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205193600000",
    "number": "1265602874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "SULLIVAN HALL ROOM 170",
            "address_2": "FACULTY PRACTICE",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948705",
            "telephone_number": "631-632-8971",
            "fax_number": "631-632-7658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SULLIVAN HALL ROOM 170",
            "address_2": "FACULTY PRACTICE",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948705",
            "telephone_number": "631-632-8971",
            "fax_number": "631-632-7658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONY BROOK DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-11",
        "last_updated": "2008-03-11",
        "status": "A",
        "authorized_official_last_name": "REINER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "631-632-8971",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "043965-1",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "031804-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01470777",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00675654",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Pediatric Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2008; 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.