Urban Pediatric Dental PC

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

0497501 Issued in NY

Legal business name

URBAN PEDIATRIC DENTAL PC

Practice address

128 Mott Street
Suite 203
New York, NY 10013-5575

Phone

(212) 965-8113

NPI assigned

Nov 16, 2010

Organization subpart

No

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

Authorized official

Name

Ms. Jessica Loo Marn, D.D.S

Title

Practice Owner

Phone

(212) 965-8113

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1289865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358985600000",
    "number": "1699076083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 MOTT STREET",
            "address_2": "SUITE 203",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100135575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 MOTT STREET",
            "address_2": "SUITE 203",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100135575",
            "telephone_number": "212-965-8113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "URBAN PEDIATRIC DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-16",
        "last_updated": "2013-01-24",
        "status": "A",
        "authorized_official_last_name": "MARN",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "LOO",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "212-965-8113",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "NY",
            "license": "0497501",
            "primary": true
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "NY",
            "license": "0535941",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02902734",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Urban Indigenous Collective, LLC
• Urban Medical Group, PLLC
• Urban Nutrition Consultants, LLC
• Urban Optometry PC
• Urban Pathways, Inc.
• Urban Resource Institue
• Emily Urban
• Jacquelyn Urban, PA-C
• Jesse Urban, OT
• Katherine Urban

• Exclusive Provider Organization in New York, NY
• Providers in New York, NY by specialty
• Exclusive Provider Organization in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2013; 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.