Madison Avenue Oral Surgery and Implant Center, PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

047288 Issued in NY

Legal business name

MADISON AVENUE ORAL SURGERY AND IMPLANT CENTER, PC

Practice address

295 Madison Ave FL 28
New York, NY 10017-6351

Phone

(212) 660-0305

NPI assigned

May 18, 2011

Last updated

Jul 9, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Moses Datson, DDSNPI 1679534580

Title

Owner

Phone

(212) 660-0305

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, and the practitioner matching its NPPES authorized official.

• Moses Datson

  • Oral and Maxillofacial Surgery (Dentist)
  • Brooklyn, NY
  • NPI 1679534580
  NPD Authorized official

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

{
    "created_epoch": "1305676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1700179124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "295 MADISON AVE FL 28",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100176351",
            "telephone_number": "212-660-0305",
            "fax_number": "718-284-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 MADISON AVE FL 28",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100176351",
            "telephone_number": "212-660-0305"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2025 Richmond Ave",
            "address_2": "Suite LL2",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103143937",
            "country_code": "US",
            "telephone_number": "718-284-5500",
            "fax_number": "718-284-5600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MADISON AVENUE ORAL SURGERY AND IMPLANT CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-18",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A",
        "authorized_official_last_name": "DATSON",
        "authorized_official_first_name": "MOSES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "212-660-0305",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "047288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02282231",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in New York, NY
• Providers in New York, NY by specialty
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; 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.