NPIMap

Organization Active NPI

43 Chruch Street Dental PC

  • Dental Clinic/Center
  • Bronx, NY
National Provider Identifier
1356097869
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
43 CHRUCH STREET DENTAL PC
Practice address
1776 Boston Rd Ste 1a
Bronx, NY 10460-4907
Phone
(347) 271-4840
Fax
(347) 271-4842
NPI assigned
Feb 23, 2022
Last updated
Aug 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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

Authorized official

Name
Alejandro Leonel Williams, DDSNPI 1073502217
Title
Owner
Phone
(718) 294-3725

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

1776 Boston Rd Ste 1a
Bronx, NY 10460-4907

Mailing address

1776 Boston Rd Ste 1a
Bronx, NY 10460-4907
Phone (347) 271-4840

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220914000695 NY Part B Supplier - Clinic/Group Practice 5395120240 Receives reassigned benefits from 21 practitioners
Practice locations: Bronx, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1645574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724803200000",
    "number": "1356097869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 BOSTON RD STE 1A",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104604907",
            "telephone_number": "347-271-4840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1776 BOSTON RD STE 1A",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104604907",
            "telephone_number": "347-271-4840",
            "fax_number": "347-271-4842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "43 CHRUCH STREET DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-23",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "ALEJANDRO",
        "authorized_official_middle_name": "LEONEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-294-3725",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.