Crest Family Dental, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

CT10690 Issued in CT

Legal business name

CREST FAMILY DENTAL, LLC

Practice address

85 Seymour St
Suite 1018
Hartford, CT 06106-5501

Phone

(860) 251-6999

Fax

(860) 251-6997

NPI assigned

May 5, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Shyam Shivareddy

Title

Manager

Phone

(904) 514-1217

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

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

• Shyam Prasad Shivareddy Peta, B.D.S., D.D.S

  • General Practice Dentistry
  • Hartford, CT
  • NPI 1720391071
  NPD (past)
• David Earle Whitehead Jr., DDS

  • Dentist
  • Hartford, CT
  • NPI 1144386160
  NPD (past)

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

{
    "created_epoch": "1399248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399248000000",
    "number": "1699185264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 SEYMOUR ST",
            "address_2": "SUITE 1018",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061065501",
            "telephone_number": "860-251-6999",
            "fax_number": "860-251-6997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 SEYMOUR ST",
            "address_2": "SUITE 1018",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061065501",
            "telephone_number": "860-251-6999",
            "fax_number": "860-251-6997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREST FAMILY DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-05",
        "last_updated": "2014-05-05",
        "status": "A",
        "authorized_official_last_name": "SHIVAREDDY",
        "authorized_official_first_name": "SHYAM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "904-514-1217",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "CT10690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1223G0001X",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Testani Creem, ATC
• Carlotta S Creevey, LCSW, LADC
• Eric M Crespo, M.D.
• Katyana Marie Crespo, BA, CJ
• Lisa Crespo
• Monica Annmarie Cresta, RN
• Mary E Cretella, LCSW
• Crystal Monette Cribs
• Joseph Michael Criniti, CRNA
• Alyssa M Crispino, PA-C

• General Practice Dentistry in Hartford, CT
• Providers in Hartford, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2014; 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.