East Village Dental Group

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

046646 Issued in NY

Legal business name

EAST VILLAGE DENTAL GROUP

Doing business as

Family Dental Center

Practice address

15 Avenue a
New York, NY 10009-7996

Phone

(212) 677-2510

Fax

(212) 228-8119

NPI assigned

Nov 3, 2006

Organization subpart

No

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

Authorized official

Name

Brenda Lee Mercado

Title

Office Manager

Phone

(212) 677-2510

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Family Dental Center Doing business as

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467531061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 AVENUE A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100097996",
            "telephone_number": "212-677-2510",
            "fax_number": "212-228-8119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 AVENUE A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100097996",
            "telephone_number": "212-677-2510",
            "fax_number": "212-228-8119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST VILLAGE DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MERCADO",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "212-677-2510"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "046646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01894339",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in New York, NY
• Providers in New York, 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 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.