Active NPI
Kenneth Wachs, DDS
- Dentist
- New York, NY
National Provider Identifier
1609934744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 046584
- Practice address
- 245 E 24TH St
New York, NY 10010-3821 - Phone
- (212) 998-9954
- NPI assigned
- Dec 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 8871 | CT | |
| Dentist | 122300000X | 046584 | NY | Primary |
Addresses
Primary practice location
245 E 24TH St
New York, NY 10010-3821
Mailing address
245 E 24TH St
New York, NY 10010-3821
Phone (212) 998-9544
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8871 | CT | MD | Oral and Maxillofacial Surgery (Dentist) |
| 046584 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Associates of CT PC | Oral and Maxillofacial Surgery | Past | Accepting new patients |
Organizations & group practices 1
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": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651708800000",
"number": "1609934744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "245 E 24TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100103821",
"telephone_number": "212-998-9544",
"fax_number": "203-748-4340"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "245 E 24TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100103821",
"telephone_number": "212-998-9954"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WACHS",
"first_name": "KENNETH",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-04",
"last_updated": "2022-05-05",
"certification_date": "2022-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "CT",
"license": "8871",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "046584",
"primary": true
}
],
"identifiers": [],
"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 May 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.