Walter E. Dornemann, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

031527 Issued in NY

Practice address

164 S Country Rd
Bellport, NY 11713-2516

Phone

(631) 286-2211

Fax

(631) 286-2168

NPI assigned

Nov 13, 2006

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

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1427120989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 S COUNTRY RD",
            "city": "BELLPORT",
            "state": "NY",
            "postal_code": "117132516",
            "telephone_number": "631-286-2211",
            "fax_number": "631-286-2168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 S COUNTRY RD",
            "city": "BELLPORT",
            "state": "NY",
            "postal_code": "117132516",
            "telephone_number": "631-286-2211",
            "fax_number": "631-286-2168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DORNEMANN",
        "first_name": "WALTER",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "031527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nathanael Desire, D.O.
• Danna Jean Diamond, LPN
• Karina Alexandra Diaz
• Erena Digonis, LCSW
• Anne Dooling, L.C.S.W.
• Dr James K Yang MD PC
• Peter Robert Drago Sr., LPN
• Maryanne Dumas, MHC-LP
• Kathia Duverne-Douyon
• Richard Edward Edstrom Jr., M.D.

• General Practice Dentistry in Bellport, NY
• Providers in Bellport, 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.