Active NPI
Bryan R Hoertdoerfer, D.D.S.
- General Practice Dentistry
- Wantagh, NY
National Provider Identifier
1427190248
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 044865
- Practice address
- 1228 Wantagh Ave
Suite 102
Wantagh, NY 11793-2209 - Phone
- (516) 679-7978
- Fax
- (516) 826-5830
- NPI assigned
- Feb 12, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 044865 | NY | Primary |
Addresses
Primary practice location
1228 Wantagh Ave
Suite 102
Wantagh, NY 11793-2209
Mailing address
9 Bayview Ave
East Setauket, NY 11733-3903
Phone (631) 675-0065
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 044865 | NY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wantagh Dental Arts, PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Hygienist
- Wantagh, NY
- NPI 1114936929
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1427190248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 BAYVIEW AVE",
"city": "EAST SETAUKET",
"state": "NY",
"postal_code": "117333903",
"telephone_number": "631-675-0065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1228 WANTAGH AVE",
"address_2": "SUITE 102",
"city": "WANTAGH",
"state": "NY",
"postal_code": "117932209",
"telephone_number": "516-679-7978",
"fax_number": "516-826-5830"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOERTDOERFER",
"first_name": "BRYAN",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "044865",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wantagh, NY
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.