Clove Lakes Family Dental PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CLOVE LAKES FAMILY DENTAL PLLC

Practice address

1140 Victory Blvd
Suite 1
Staten Island, NY 10301-3673

Phone

(718) 255-8995

NPI assigned

Mar 2, 2017

Organization subpart

No

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

Authorized official

Name

Emanuel Graziano, DDS

Title

Partner

Phone

(718) 873-4889

Specialties & licenses 1

Addresses

Other names 1

• Oakwood Dental Arts of Clove Lakes Doing business as

Locations

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

{
    "created_epoch": "1488412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488412800000",
    "number": "1639619208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 VICTORY BLVD",
            "address_2": "SUITE 1",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103013673",
            "telephone_number": "718-255-8995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 VICTORY BLVD",
            "address_2": "SUITE 1",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103013673",
            "telephone_number": "718-255-8995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLOVE LAKES FAMILY DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-02",
        "last_updated": "2017-03-02",
        "status": "A",
        "authorized_official_last_name": "GRAZIANO",
        "authorized_official_first_name": "EMANUEL",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "718-873-4889",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oakwood Dental Arts of Clove Lakes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dental Clinic/Center in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Dental Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2017; 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.