NPIMap

Organization Active NPI

Grand Smile Dental

  • Dentist
  • Maspeth, NY
National Provider Identifier
1467706689
Registry record updated Nov 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
050666 Issued in NY
Legal business name
GRAND SMILE DENTAL
Practice address
6977 Grand Ave
Maspeth, NY 11378-1826
Phone
(718) 255-1381
Fax
(718) 255-1385
NPI assigned
Nov 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2012

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

Authorized official

Name
Dr. Alexandra Khaimov, DDS
Title
Dentist
Phone
(718) 255-1381

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 050666 NY Primary

Addresses

Primary practice location

6977 Grand Ave
Maspeth, NY 11378-1826

Mailing address

6977 Grand Ave
Maspeth, NY 11378-1826
Phone (718) 255-1381

Other identifiers 1

IdentifierTypeStateIssuer
02408982MedicaidNY

National Provider Directory

National Provider Directory

Locations

6977 Grand Ave
Maspeth, NY 11378
Phone (718) 255-1381

NPI Registry JSON

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

{
    "created_epoch": "1352419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352419200000",
    "number": "1467706689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6977 GRAND AVE",
            "city": "MASPETH",
            "state": "NY",
            "postal_code": "113781826",
            "telephone_number": "718-255-1381",
            "fax_number": "718-255-1385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6977 GRAND AVE",
            "city": "MASPETH",
            "state": "NY",
            "postal_code": "113781826",
            "telephone_number": "718-255-1381",
            "fax_number": "718-255-1385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND SMILE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-09",
        "last_updated": "2012-11-09",
        "status": "A",
        "authorized_official_last_name": "KHAIMOV",
        "authorized_official_first_name": "ALEXANDRA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "718-255-1381",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "050666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02408982",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maspeth, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2012; 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.