Superior Dental

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

049663 Issued in NY

Legal business name

SUPERIOR DENTAL

Practice address

2475 Grand Concourse
Bronx, NY 10468-5443

Phone

(718) 329-2929

Fax

(718) 329-2930

NPI assigned

Jan 29, 2009

Last updated

Jan 29, 2009By 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. Svetlana Ponomareva, DDS

Title

Owner

Phone

(718) 329-2929

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1233187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233187200000",
    "number": "1275771248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2475 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104685443",
            "telephone_number": "718-329-2929",
            "fax_number": "718-329-2930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2475 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104685443",
            "telephone_number": "718-329-2929",
            "fax_number": "718-329-2930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERIOR DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-29",
        "last_updated": "2009-01-29",
        "status": "A",
        "authorized_official_last_name": "PONOMAREVA",
        "authorized_official_first_name": "SVETLANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-329-2929",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NY",
            "license": "049663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02224179",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Bronx, NY
• Providers in Bronx, NY by specialty
• Dental Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 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.