Bronx River Dental P.C.

Primary specialty

Dental TherapistTaxonomy code 125J00000X

License

046846 Issued in NY

Legal business name

BRONX RIVER DENTAL P.C.

Practice address

3000 Bronx Park E
Bronx, NY 10467-6711

Phone

(718) 655-0075

Fax

(718) 708-6966

NPI assigned

Jan 29, 2013

Last updated

Nov 14, 2013By 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. Ezro Fattakhov, DDS

Title

Doctor/Owner

Phone

(718) 456-2626

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1359417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384387200000",
    "number": "1336487131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 BRONX PARK E",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104676711",
            "telephone_number": "718-655-0075",
            "fax_number": "718-708-6966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 BRONX PARK E",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104676711",
            "telephone_number": "718-655-0075",
            "fax_number": "718-708-6966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRONX RIVER DENTAL P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-29",
        "last_updated": "2013-11-14",
        "status": "A",
        "authorized_official_last_name": "FATTAKHOV",
        "authorized_official_first_name": "EZRO",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "718-456-2626",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "125J00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dental Therapist",
            "state": "NY",
            "license": "046846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bronx Queens Dental Care PC
• Bronx Radiology P.C.
• Bronx Regional High School
• Bronx Rehabilitation Medicine & Physical Therapy LLC
• Bronx Renal Services LLC
• Bronx River Medical Associates,PC
• Bronx River Nephro-Care Inc.
• Bronx River Nephro-Care Inc.
• Bronx SC LLC (Empire State Ambulatory Surgery Center)
• Bronx Specialty Pharmacy Inc

• Dental Therapist in Bronx, NY
• Providers in Bronx, NY by specialty
• Dental Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2013; 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.