Dentrust Dental New York, P.C

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

DENTRUST DENTAL NEW YORK, P.C

Practice address

254 Cafferty Rd
Pipersville, PA 18947-9337

Phone

(610) 294-7994

Fax

(610) 294-7995

NPI assigned

Oct 10, 2006

Organization subpart

No

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

Authorized official

Name

Amanda Clark

Title

Director of Credentialing

Phone

(672) 362-5938

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676851200000",
    "number": "1629166533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "254 CAFFERTY RD",
            "city": "PIPERSVILLE",
            "state": "PA",
            "postal_code": "189479337",
            "telephone_number": "610-294-7994",
            "fax_number": "610-294-7995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "254 CAFFERTY RD",
            "city": "PIPERSVILLE",
            "state": "PA",
            "postal_code": "189479337",
            "telephone_number": "610-294-7994",
            "fax_number": "610-294-7995"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Bldg 10730A",
            "address_2": "Enduring Freedom Dr",
            "address_purpose": "LOCATION",
            "city": "Ft. Drum",
            "state": "NY",
            "postal_code": "13602",
            "country_code": "US",
            "telephone_number": "267-927-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DENTRUST DENTAL NEW YORK, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-20",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "672-362-5938"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LC LIC NY",
            "identifier": "046252-01",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Pipersville, PA
• Providers in Pipersville, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2023; 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.