NPIMap

Organization Active NPI

LS Dental PC

  • General Practice Dentistry
  • Woodside, NY
National Provider Identifier
1609044023
Registry record updated Feb 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
048978-1 Issued in NY
Legal business name
LS DENTAL PC
Doing business as
ls dental pc
Practice address
4705 44TH St Apt A2
Woodside, NY 11377-6301
Phone
(718) 752-9000
Fax
(718) 440-9460
NPI assigned
Feb 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2008

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

Authorized official

Name
Dr. Leonid ShimanovNPI 1811045016
Title
Dentist
Phone
(718) 752-9000

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 048978-1 NY Primary

Addresses

Primary practice location

4705 44TH St Apt A2
Woodside, NY 11377-6301

Mailing address

4705 44TH St Apt A2
Woodside, NY 11377-6301
Phone (718) 752-9000

Other identifiers 1

IdentifierTypeStateIssuer
02259492MedicaidNY

Other names 1

  • ls dental pc Doing business as

National Provider Directory

National Provider Directory

Locations

4705 44th St
Ste A2
Woodside, NY 11377
Phone (718) 215-0812

Practitioners & affiliated clinicians

Practitioners 6

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": "1203379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203379200000",
    "number": "1609044023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4705 44TH ST APT A2",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113776301",
            "telephone_number": "718-752-9000",
            "fax_number": "718-440-9460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705 44TH ST APT A2",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113776301",
            "telephone_number": "718-752-9000",
            "fax_number": "718-440-9460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LS DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-19",
        "last_updated": "2008-02-19",
        "status": "A",
        "authorized_official_last_name": "SHIMANOV",
        "authorized_official_first_name": "LEONID",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "718-752-9000",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "048978-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02259492",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ls dental pc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodside, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2008; 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.