X Collado Dental Center

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

045798-1 Issued in NY

Legal business name

X COLLADO DENTAL CENTER

Practice address

10105 77TH St
Ozone Park, NY 11416-1904

Phone

(718) 323-1288

Fax

(718) 323-0291

NPI assigned

Oct 30, 2009

Organization subpart

No

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

Authorized official

Name

Juana X Collado-Medina, D.D.S

Title

X Collado Dental Center

Phone

(718) 323-1288

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Juana X Medina, DDS

  • Dentist
  • Ozone Paark, NY
  • NPI 1760532303
  NPD (past)

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

{
    "created_epoch": "1256860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256860800000",
    "number": "1649506353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10105 77TH ST",
            "city": "OZONE PARK",
            "state": "NY",
            "postal_code": "114161904",
            "telephone_number": "718-323-1288",
            "fax_number": "718-323-0291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10105 77TH ST",
            "city": "OZONE PARK",
            "state": "NY",
            "postal_code": "114161904",
            "telephone_number": "718-323-1288",
            "fax_number": "718-323-0291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "X COLLADO DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-30",
        "last_updated": "2009-10-30",
        "status": "A",
        "authorized_official_last_name": "COLLADO-MEDINA",
        "authorized_official_first_name": "JUANA",
        "authorized_official_middle_name": "X",
        "authorized_official_title_or_position": "X COLLADO DENTAL CENTER",
        "authorized_official_telephone_number": "718-323-1288",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "045798-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01558754",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Ozone Park, NY
• Providers in Ozone Park, 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 Oct 30, 2009; 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.