NPIMap

Organization Active NPI

Gouverneur Dental Associates, P.C.

  • Dentist
  • Gouverneur, NY
National Provider Identifier
1407846306
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
040862 Issued in NY
Legal business name
GOUVERNEUR DENTAL ASSOCIATES, P.C.
Practice address
354 E Main St
Gouverneur, NY 13642-1512
Phone
(315) 287-4000
Fax
(315) 287-4109
NPI assigned
Oct 24, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Scott R. Day, DDSNPI 1538293675
Title
President
Phone
(315) 287-4000

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
Dentist 122300000X 040862 NY Primary

Addresses

Primary practice location

354 E Main St
Gouverneur, NY 13642-1512

Mailing address

354 E Main St
PO Box 427
Gouverneur, NY 13642-1512
Phone (315) 287-4000

Other identifiers 2

IdentifierTypeStateIssuer
01134569MedicaidNY
02572989MedicaidNY

National Provider Directory

National Provider Directory

Locations

354 E Main St
Gouverneur, NY 13642
Phone (315) 287-4000

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407846306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "354 E MAIN ST",
            "address_2": "PO BOX 427",
            "city": "GOUVERNEUR",
            "state": "NY",
            "postal_code": "136421512",
            "telephone_number": "315-287-4000",
            "fax_number": "315-287-4109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 E MAIN ST",
            "city": "GOUVERNEUR",
            "state": "NY",
            "postal_code": "136421512",
            "telephone_number": "315-287-4000",
            "fax_number": "315-287-4109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOUVERNEUR DENTAL ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAY",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "315-287-4000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "040862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01134569",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02572989",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gouverneur, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.