Dr. Brian Ketover DMD LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

035400 Issued in NY

Legal business name

DR. BRIAN KETOVER DMD LLC

Practice address

580 5TH Ave
Brooklyn, NY 11215-5436

Phone

(718) 768-8400

Fax

(718) 768-7450

NPI assigned

Jul 21, 2011

Last updated

Jul 21, 2011By 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

Brian Ketover, DMDNPI 1689772196

Title

Dentist

Phone

(718) 168-8400

Specialties & licenses 1

Addresses

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.

• Brian Michael Ketover, DMD

  • Dentist
  • Brooklyn, NY
  • NPI 1689772196
  Authorized official Same address or phone

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

{
    "created_epoch": "1311206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311206400000",
    "number": "1710275987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 5TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112155436",
            "telephone_number": "718-768-8400",
            "fax_number": "718-768-7450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 5TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112155436",
            "telephone_number": "718-768-8400",
            "fax_number": "718-768-7450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. BRIAN KETOVER DMD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-21",
        "last_updated": "2011-07-21",
        "status": "A",
        "authorized_official_last_name": "KETOVER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "718-168-8400",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "035400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2011; 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.