Pediatric Dentistry of Suffolk County

Primary specialty

DentistTaxonomy code 122300000X

License

050315 Issued in NY

Legal business name

PEDIATRIC DENTISTRY OF SUFFOLK COUNTY

Practice address

2171 Jericho Tpke
Suite 145
Commack, NY 11725-2937

Phone

(631) 486-6364

NPI assigned

Jun 14, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Michael Ioannou

Title

Pediatric Dentist

Phone

(631) 486-6364

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1339632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339632000000",
    "number": "1407118540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2171 JERICHO TPKE",
            "address_2": "SUITE 145",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117252937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2171 JERICHO TPKE",
            "address_2": "SUITE 145",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117252937",
            "telephone_number": "631-486-6364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY OF SUFFOLK COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-14",
        "last_updated": "2012-06-14",
        "status": "A",
        "authorized_official_last_name": "IOANNOU",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "631-486-6364",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "050315",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "053854-1",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "054175",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neha S Pawar, M.D.
• Angela Paz, LMHC
• PCL Hearing Services LLC
• Mariah T Pearson
• Christine Pedersen
• Pediatric Physical Therapy Associates of Western Suffolk, P.C.
• Pediatric Pulmonary Medicine PC
• Pegasus Physical Therapy, P.C.
• Digna Maricela Pena-Hollwedel, MS
• Alexandra Marte Penalver

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2012; 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.