Upper Ditmars Dental PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

052126 Issued in NY

Legal business name

UPPER DITMARS DENTAL PLLC

Practice address

2128 80TH St
East Elmhurst, NY 11370-1323

Phone

(908) 705-7122

NPI assigned

Jan 10, 2017

Last updated

Jan 10, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Aristotle Lyssikatos, DDS

Title

Owner

Phone

(908) 705-7122

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1484006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484006400000",
    "number": "1437695764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2128 80TH ST",
            "city": "EAST ELMHURST",
            "state": "NY",
            "postal_code": "113701323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2128 80TH ST",
            "city": "EAST ELMHURST",
            "state": "NY",
            "postal_code": "113701323",
            "telephone_number": "908-705-7122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER DITMARS DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-10",
        "last_updated": "2017-01-10",
        "status": "A",
        "authorized_official_last_name": "LYSSIKATOS",
        "authorized_official_first_name": "ARISTOTLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-705-7122",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NY",
            "license": "052126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in East Elmhurst, NY
• Providers in East Elmhurst, NY by specialty
• Dental Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2017; 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.