Jaime M Poulos, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

052074 Issued in NY

Practice address

120 New York Ave Ste 2W
Huntington, NY 11743-2743

Phone

(631) 673-3755

Fax

(631) 673-3433

NPI assigned

Jun 17, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Dr. Jaime M. Poulos, DDS P.C.

  • Dental Clinic/Center
  • Huntington, NY
  • NPI 1609397108
  NPD Authorized official
• John G Poulos DDS

  • Prosthodontics
  • Northport, NY
  • NPI 1932597606
  NPD (past)

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

{
    "created_epoch": "1213660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712620800000",
    "number": "1619138229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 DITMAR LN",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "117315220",
            "telephone_number": "516-729-6799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 NEW YORK AVE STE 2W",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117432743",
            "telephone_number": "631-673-3755",
            "fax_number": "631-673-3433"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22 Laurel Ave",
            "address_purpose": "LOCATION",
            "city": "Northport",
            "state": "NY",
            "postal_code": "117683165",
            "country_code": "US",
            "telephone_number": "631-262-0644",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POULOS",
        "first_name": "JAIME",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-17",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026797",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "052074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara K Posillico, L.C.S.W.
• Kay A. Posillico, L.C.S.W.
• Christie Posner, MS LAC
• Lois Ann Posner, LMT
• Michael Posner, D.C.
• Jennifer Katherine Pralle Broderick
• Michelle Prata
• Deandra Loren Pratt, LMT
• Precision Digestive Care, PC
• Precision Ultrasound LLC

• General Practice Dentistry in Huntington, NY
• Providers in Huntington, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; 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.