Individual provider Active NPI

Ricardo Omar Miguel, D.D.S.

  • General Practice Dentistry
  • New York, NY
National Provider Identifier
1336138775
Registry record updated Jul 31, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
043710 Issued in NY
Practice address
341A Wadsworth Ave
New York, NY 10040-3143
Phone
(212) 795-4475
NPI assigned
Oct 18, 2005
Last updated
Jul 31, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2007

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 043710 NY Primary

Addresses

Primary practice location

341A Wadsworth Ave
New York, NY 10040-3143

Mailing address

341A Wadsworth Ave
New York, NY 10040-3143
Phone (212) 795-4475

Other identifiers 1

IdentifierTypeStateIssuer
01268620MedicaidNY

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
043710NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Wadsworth Family Dentistry, P.C. 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": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185840000000",
    "number": "1336138775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "341A WADSWORTH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100403143",
            "telephone_number": "212-795-4475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "341A WADSWORTH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100403143",
            "telephone_number": "212-795-4475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIGUEL",
        "first_name": "RICARDO",
        "middle_name": "OMAR",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-18",
        "last_updated": "2007-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "043710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01268620",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2007; 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.