Active NPI
David James Maricondo, DDS
- Dentist
- Oswego, NY
National Provider Identifier
1467880617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 056680-1
- Practice address
- 137 State Route 104
Oswego, NY 13126-2937 - Phone
- (315) 326-1197
- NPI assigned
- Oct 25, 2013
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 056680-1 | NY | Primary |
Addresses
Primary practice location
137 State Route 104
Oswego, NY 13126-2937
Mailing address
26546 San Torini Rd
Mission Viejo, CA 92692-6101
Phone (949) 367-1882
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 |
|---|---|---|---|
| 056680-1 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1382659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1382659200000",
"number": "1467880617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26546 SAN TORINI RD",
"city": "MISSION VIEJO",
"state": "CA",
"postal_code": "926926101",
"telephone_number": "949-367-1882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "137 STATE ROUTE 104",
"city": "OSWEGO",
"state": "NY",
"postal_code": "131262937",
"telephone_number": "315-326-1197"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARICONDO",
"first_name": "DAVID",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-10-25",
"last_updated": "2013-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "056680-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oswego, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.