Christiaan Andrew Ditolla, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

047724 Issued in NY

Practice address

971 Broadway Ave
Holbrook, NY 11741-4961

Phone

(631) 589-8451

NPI assigned

May 9, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1336353424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "354 WATERSIDE RD",
            "city": "NORTHPORT",
            "state": "NY",
            "postal_code": "117681258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 BROADWAY AVE",
            "city": "HOLBROOK",
            "state": "NY",
            "postal_code": "117414961",
            "telephone_number": "631-589-8451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DITOLLA",
        "first_name": "CHRISTIAAN",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "047724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02325675",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Dibenedetto
• Jillian Difalco, LMHC
• Jennifer Marie Dilluvio
• Robin L. Dinerstein
• Edward Johnathan Dipasquale
• William James Ditolla, D.D.S.
• Divine Developmental Services LLC
• Debra Ann Dobbs, D.D.S.
• David Charles Donner, PT
• Cathy Ann O'Malley Doran

• General Practice Dentistry in Holbrook, NY
• Providers in Holbrook, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.