Alta Dental LLC

Key facts

NPI

1508698556

Entity type

Organization (NPI type 2)

Primary specialty

Dental Clinic/Center 261QD0000X

Legal business name

ALTA DENTAL LLC

Practice address

901 Teaneck Rd FL 2N
Teaneck, NJ 07666-4511

Phone

(201) 837-2727

NPI assigned

Aug 19, 2024

Organization subpart

No

Authorized official

Name

Dr. Altay Khanmamedov, DDS NPI 1437114170

Title

Owner/Provider

Phone

(917) 881-5977

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

Practitioners 1

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

• Altay Khanmamedov, DDS Dentist · New York, NY · NPI 1437114170
  NPD Authorized official

National Provider Directory

Locations

Specialties & licenses

Addresses

Other names

• ALTA DENTAL LLC Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 19, 2024.

{
    "created_epoch": "1724025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1508698556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 TEANECK RD FL 2N",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664511",
            "telephone_number": "201-837-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 TEANECK RD FL 2N",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664511",
            "telephone_number": "201-837-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-19",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-18",
        "status": "A",
        "authorized_official_last_name": "KHANMAMEDOV",
        "authorized_official_first_name": "ALTAY",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "917-881-5977",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ALTA DENTAL LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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