Individual provider Active NPI

Maria Grammenos - Georgakopoulos, DDS

  • General Practice Dentistry
  • Nesconset, NY
National Provider Identifier
1487725339
Registry record updated Mar 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
46897 Issued in NY
Practice address
110 Smithtown Blvd Ste 1
Nesconset, NY 11767-2075
Phone
(631) 382-8585
Fax
(631) 382-8580
NPI assigned
Nov 13, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 26, 2025

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 46897 NY Primary

Addresses

Primary practice location

110 Smithtown Blvd Ste 1
Nesconset, NY 11767-2075

Mailing address

110 Smithtown Blvd Ste 1
Nesconset, NY 11767-2075
Phone (631) 382-8585

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
I20160527001214 NY Order and Referring Only - DentistPractitioner - Dentist 2163712498

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
46897NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Sound Sleep Solutions LLC CurrentSince May 1, 2022 Accepting new patients
Sachem Oral Surgery, PLLC Past Accepting new patients

Locations

110 Smithtown Blvd
Nesconset, NY 11767
Phone (631) 382-8585

110 Smithtown Blvd
Ste 1
Nesconset, NY 11767
Phone (631) 382-8585

235 Boyle Rd
Selden, NY 11784
Phone (631) 732-8338

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742947200000",
    "number": "1487725339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 SMITHTOWN BLVD STE 1",
            "city": "NESCONSET",
            "state": "NY",
            "postal_code": "117672075",
            "telephone_number": "631-382-8585",
            "fax_number": "631-382-8580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 SMITHTOWN BLVD STE 1",
            "city": "NESCONSET",
            "state": "NY",
            "postal_code": "117672075",
            "telephone_number": "631-382-8585",
            "fax_number": "631-382-8580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAMMENOS - GEORGAKOPOULOS",
        "first_name": "MARIA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "46897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nesconset, NY

Sources for this page

Verify at the official NPI Registry.