NPIMap

Organization Active NPI

Sachem Oral Surgery, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Nesconset, NY
National Provider Identifier
1669795332
Registry record updated Mar 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
050522 Issued in NY
Legal business name
SACHEM ORAL SURGERY, PLLC
Practice address
110 Smithtown Blvd
Nesconset, NY 11767-1748
Phone
(631) 382-8585
Fax
(631) 382-8580
NPI assigned
Mar 9, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2010

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

Authorized official

Name
Dr. Christopher Matthew Amenedo, D.D.S.
Title
Owner
Phone
(631) 382-8585

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 050522 NY Primary

Addresses

Primary practice location

110 Smithtown Blvd
Nesconset, NY 11767-1748

Mailing address

110 Smithtown Blvd
Nesconset, NY 11767-1748
Phone (631) 382-8585

National Provider Directory

National Provider Directory

Locations

110 Smithtown Blvd
Nesconset, NY 11767
Phone (631) 382-8585

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1268092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268092800000",
    "number": "1669795332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 SMITHTOWN BLVD",
            "city": "NESCONSET",
            "state": "NY",
            "postal_code": "117671748",
            "telephone_number": "631-382-8585",
            "fax_number": "631-382-8580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 SMITHTOWN BLVD",
            "city": "NESCONSET",
            "state": "NY",
            "postal_code": "117671748",
            "telephone_number": "631-382-8585",
            "fax_number": "631-382-8580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACHEM ORAL SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-09",
        "last_updated": "2010-03-09",
        "status": "A",
        "authorized_official_last_name": "AMENEDO",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-382-8585",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "050522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nesconset, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2010; 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.