Individual provider Active NPI

Thomas Maxwell Thaney, D.D.S.

  • General Practice Dentistry
  • Brockport, NY
National Provider Identifier
1275759334
Registry record updated Mar 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
51292 Issued in NY
Practice address
64 N Main St
Brockport, NY 14420-1649
Phone
(585) 637-6884
NPI assigned
Apr 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 51292 NY Primary

Addresses

Primary practice location

64 N Main St
Brockport, NY 14420-1649

Mailing address

423 Stone Fence Rd
Rochester, NY 14626-3187
Phone (585) 368-0694

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
I20160617001715 NY Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 5890086086

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
51292NYMDGeneral Practice Dentistry
051292NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Thomas Maxwell Thaney D.D.S. General Practice Current Accepting new patients

Locations

64 N Main St
Brockport, NY 14420
Phone (585) 637-6884

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268352000000",
    "number": "1275759334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "423 STONE FENCE RD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146263187",
            "telephone_number": "585-368-0694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 N MAIN ST",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201649",
            "telephone_number": "585-637-6884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THANEY",
        "first_name": "THOMAS",
        "middle_name": "MAXWELL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-17",
        "last_updated": "2010-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "51292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockport, NY

Sources for this page

Verify at the official NPI Registry.