Elevation Dental Studio, DMD, P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ELEVATION DENTAL STUDIO, DMD, P.C.

Practice address

545 Gramatan Ave Unit B
Mount Vernon, NY 10552-2103

Phone

(914) 259-8559

NPI assigned

Sep 24, 2019

Organization subpart

No

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

Authorized official

Name

Mitz-Ann Edmond, DMD

Title

Dentist / Owner

Phone

(914) 259-8559

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1569283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1467003160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 GRAMATAN AVE UNIT B",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "105522103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 GRAMATAN AVE UNIT B",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "105522103",
            "telephone_number": "914-259-8559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEVATION DENTAL STUDIO, DMD, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-24",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "EDMOND",
        "authorized_official_first_name": "MITZ-ANN",
        "authorized_official_title_or_position": "DENTIST / OWNER",
        "authorized_official_telephone_number": "914-259-8559",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03232928",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1740516525",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "URL",
            "affiliation": "N",
            "address_1": "545 Gramatan Ave Unit B",
            "city": "Mount Vernon",
            "state": "NY",
            "country_code": "US",
            "postal_code": "105522103",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• General Practice Dentistry in Mount Vernon, NY
• Providers in Mount Vernon, 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 Mar 7, 2023; 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.