Jonah Peter Spaeth, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

063505 Issued in NY

Practice address

3237 Ny-112
BLDG 6 Suite 7B
Medford, NY 11763

Phone

(631) 320-0880

NPI assigned

May 3, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694995200000",
    "number": "1700469244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3237 NY-112",
            "address_2": "BLDG 6 SUITE 7B",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "11763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3237 NY-112",
            "address_2": "BLDG 6 SUITE 7B",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "11763",
            "telephone_number": "631-320-0880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPAETH",
        "first_name": "JONAH",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-05-03",
        "last_updated": "2023-09-18",
        "certification_date": "2023-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "063505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sydney Smith
• Shaun Lamont Snead
• Angela Sorice, NPP
• South Island Podiatry Specialists,PC
• Tracey Marie Southard
• Natale F Spata, D.C.
• Felicia Splaine
• Crystal Lynn Stamm, RN
• Lauren Standridge, FNP-BC
• Alan Richard Stern, DPM

• Pediatric Dentistry in Medford, NY
• Providers in Medford, NY by specialty
• Pediatric Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; 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.