Active NPI
Athena Diamandis, DMD
- General Practice Dentistry
- Brockport, NY
National Provider Identifier
1457505612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 000077-1
- Practice address
- 300 West Ave
Brockport, NY 14420-1118 - Phone
- (585) 637-3905
- Fax
- (585) 637-4990
- NPI assigned
- Nov 13, 2008
- Last updated
- Nov 13, 2008
- Sex
- Female
- 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 | 000077-1 | NY | Primary |
Addresses
Primary practice location
300 West Ave
Brockport, NY 14420-1118
Mailing address
300 West Ave
Brockport, NY 14420-1118
Phone (585) 637-3905
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 161020913 | Other | NY | EMPLOYER TAX ID |
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 |
|---|---|---|---|
| 000077-1 | NY | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1226534400000",
"number": "1457505612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 WEST AVE",
"city": "BROCKPORT",
"state": "NY",
"postal_code": "144201118",
"telephone_number": "585-637-3905",
"fax_number": "585-637-4990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 WEST AVE",
"city": "BROCKPORT",
"state": "NY",
"postal_code": "144201118",
"telephone_number": "585-637-3905",
"fax_number": "585-637-4990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAMANDIS",
"first_name": "ATHENA",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-13",
"last_updated": "2008-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "000077-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPLOYER TAX ID",
"identifier": "161020913",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brockport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.