NPIMap

Organization Active NPI

Dental Passion LLC

  • Dentist
  • New York, NY
National Provider Identifier
1497054647
Registry record updated Mar 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
050025 Issued in NY
Legal business name
DENTAL PASSION LLC
Practice address
164 W 96TH St
New York, NY 10025-6402
Phone
(212) 749-0600
Fax
(212) 222-4248
NPI assigned
Mar 26, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2011

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

Authorized official

Name
Dr. Robert Shick, DMDNPI 1700092285
Title
Dentist
Phone
(212) 749-0600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 050025 NY Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 053415 NY

Addresses

Primary practice location

164 W 96TH St
New York, NY 10025-6402

Mailing address

164 W 96TH St
New York, NY 10025-6402
Phone (212) 749-0600

Other identifiers 2

IdentifierTypeStateIssuer
03079921MedicaidNY
02966338MedicaidNY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1301097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301097600000",
    "number": "1497054647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 W 96TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100256402",
            "telephone_number": "212-749-0600",
            "fax_number": "212-222-4248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 W 96TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100256402",
            "telephone_number": "212-749-0600",
            "fax_number": "212-222-4248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PASSION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-26",
        "last_updated": "2011-03-26",
        "status": "A",
        "authorized_official_last_name": "SHICK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "212-749-0600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "050025",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "053415",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03079921",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02966338",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2011; 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.