Professional Dental Office PC

Primary specialty

DentistTaxonomy code 122300000X

License

0484311 Issued in NY

Legal business name

PROFESSIONAL DENTAL OFFICE PC

Practice address

167 Rivington St
New York, NY 10002

Phone

(212) 673-9367

Fax

(212) 673-9367

NPI assigned

Mar 14, 2006

Organization subpart

No

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

Authorized official

Name

Rosa I Diaz, DDS

Title

Owner

Phone

(718) 602-5200

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Professional Dental Office PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Professional Dental Office PC.

  • Dentist
  • New York, NY
  • NPI 1073659074
  NPD tax ID

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457320301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1323 MYRTLE AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11221",
            "telephone_number": "718-602-5200",
            "fax_number": "718-602-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 RIVINGTON ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10002",
            "telephone_number": "212-673-9367",
            "fax_number": "212-673-9367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL OFFICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DIAZ",
        "authorized_official_first_name": "ROSA",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-602-5200",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "0484311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01979033",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amber Proctor-Reyes, PHD
• Lenore F Proctor, PSYD
• Iordanka P Prodanova, DDS
• Professional Car Service
• Professional Clinical Laboratories
• Professional Dental Office PC.
• Professional Dental Service
• Professional Evaluation Medical Group
• Professional Medical Healthcare Service of New York
• Professional Medical Healthcare Service of New York, PC

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

• 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.