NPIMap

Organization Active NPI

PM Dental Services P.C.

  • General Practice Dentistry
  • Rosedale, NY
National Provider Identifier
1639353345
Registry record updated Dec 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
037149 Issued in NY
Legal business name
PM DENTAL SERVICES P.C.
Practice address
23520 147TH Ave
Suite# 3
Rosedale, NY 11422-3293
Phone
(718) 723-4878
NPI assigned
Dec 18, 2007
Organization subpart
Yes
Parent organization
PMDENTAL SERVICES PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 18, 2007

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

Authorized official

Name
Dr. Paul Hennis, DDSNPI 1679562227
Title
Dentist
Phone
(631) 748-6136

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 037149 NY Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 041974 NY

Addresses

Primary practice location

23520 147TH Ave
Suite# 3
Rosedale, NY 11422-3293

Mailing address

299 Candlewood Path
Dix Hills, NY 11746-8003
Phone (631) 748-6136

Other identifiers 2

IdentifierTypeStateIssuer
01109815MedicaidNY
00739359MedicaidNY

Other names 1

  • PAUL HENNIS DDS -MANAL GERGES DDS Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
PM Dental Services PC3 organizations share this tax ID, including this one
Part of
PM Dental Services PC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

23520 147th Ave
Ste 3
Rosedale, NY 11422
Phone (718) 723-4878

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1197936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197936000000",
    "number": "1639353345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "299 CANDLEWOOD PATH",
            "city": "DIX HILLS",
            "state": "NY",
            "postal_code": "117468003",
            "telephone_number": "631-748-6136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23520 147TH AVE",
            "address_2": "SUITE# 3",
            "city": "ROSEDALE",
            "state": "NY",
            "postal_code": "114223293",
            "telephone_number": "718-723-4878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PM DENTAL SERVICES P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PMDENTAL SERVICES PC",
        "enumeration_date": "2007-12-18",
        "last_updated": "2007-12-18",
        "status": "A",
        "authorized_official_last_name": "HENNIS",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "631-748-6136",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "037149",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "041974",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01109815",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00739359",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PAUL HENNIS DDS -MANAL GERGES DDS",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Rosedale, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2007; 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.