Marissa Obiedzinski, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

061586-01 Issued in NY

Practice address

111 E 57TH St Ste 204
New York, NY 10022-2009

Phone

(917) 512-8302

Fax

(732) 631-8525

NPI assigned

Apr 10, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Arora Dental PC

  dba SPA Dental Group

  • Dental Clinic/Center
  • New York, NY
  • NPI 1982363107
  NPD
• Spa Dental Group Inc.

  • Dental Clinic/Center
  • New York, NY
  • NPI 1346886884
  NPD

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

{
    "created_epoch": "1491782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625616000000",
    "number": "1295268936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 57TH ST STE 204",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100222009",
            "telephone_number": "917-512-8302",
            "fax_number": "732-631-8525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E 57TH ST STE 204",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100222009",
            "telephone_number": "917-512-8302",
            "fax_number": "732-631-8525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBIEDZINSKI",
        "first_name": "MARISSA",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-10",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "061586-01",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adaeze Flora Obi
• Vivian C Obi
• Joseph Uchechukwu Obiajulu, MD
• Ngozi Obicheta, B.S PHARMACY
• Laziza Obidova
• Cecilia C Obijuru, R.PH.
• Mohan Raj Obilisundar, M.D.
• Shirley Chinyere Obioha, M.D.
• Jaime Obletz, OTR/L
• Lara S Oboler, MD

• Dentist in New York, NY
• Providers in New York, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2021; 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.