Premier Family Dentistry PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

050241 Issued in NY

Legal business name

PREMIER FAMILY DENTISTRY PLLC

Practice address

3024 Kingsbridge Ave
Bronx, NY 10463-5121

Phone

(718) 543-4747

Fax

(718) 884-6137

NPI assigned

Feb 16, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Gabriel Adeyemi Isioye, DDSNPI 1942281829

Title

Owner

Phone

(718) 543-4747

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PREMIER FAMILY DENTISTRY Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

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

• Gabriel A Isioye, DDS

  • Dentist
  • Bronx, NY
  • NPI 1942281829
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1455580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455580800000",
    "number": "1679932818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3024 KINGSBRIDGE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104635121",
            "telephone_number": "718-543-4747",
            "fax_number": "718-884-6137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3024 KINGSBRIDGE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104635121",
            "telephone_number": "718-543-4747",
            "fax_number": "718-884-6137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER FAMILY DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-16",
        "last_updated": "2016-02-16",
        "status": "A",
        "authorized_official_last_name": "ISIOYE",
        "authorized_official_first_name": "GABRIEL",
        "authorized_official_middle_name": "ADEYEMI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-543-4747",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NY",
            "license": "050241",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02419776",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PREMIER FAMILY DENTISTRY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dental Clinic/Center in Bronx, NY
• Providers in Bronx, 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 Feb 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.