Individual provider Active NPI

John Paul Gentile, DDS

  • General Practice Dentistry
  • Kings Park, NY
National Provider Identifier
1477764090
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0485721 Issued in NY
Practice address
7 Meridian Ave
Kings Park, NY 11754
Phone
(631) 269-6206
Fax
(631) 269-3178
NPI assigned
May 25, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 0485721 NY Primary

Addresses

Primary practice location

7 Meridian Ave
Kings Park, NY 11754

Mailing address

7 Meridian Ave
Kings Park, NY 11754
Phone (631) 269-6206

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150904000766 NY Order and Referring Only - DentistPractitioner - Dentist 5991026734

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0485721NYMDGeneral Practice Dentistry
048572NYMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477764090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 MERIDIAN AVE",
            "city": "KINGS PARK",
            "state": "NY",
            "postal_code": "11754",
            "telephone_number": "631-269-6206",
            "fax_number": "631-269-3178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 MERIDIAN AVE",
            "city": "KINGS PARK",
            "state": "NY",
            "postal_code": "11754",
            "telephone_number": "631-269-6206",
            "fax_number": "631-269-3178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENTILE",
        "first_name": "JOHN",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "0485721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kings Park, NY

Sources for this page

Verify at the official NPI Registry.