NPIMap

Organization Active NPI

Manhattan Park Dental, PLLC

  • General Practice Dentistry
  • New York, NY
National Provider Identifier
1720888910
Registry record updated Mar 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MANHATTAN PARK DENTAL, PLLC
Practice address
30 Central Park S RM 11C
New York, NY 10019-1628
Phone
(212) 702-8675
Fax
(212) 702-8675
NPI assigned
Mar 17, 2025
Last updated
Mar 28, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2025

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

Authorized official

Name
Dr. Camille Suzette San Miguel, DDSNPI 1477051787
Title
President
Phone
(240) 491-7171

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X
General Practice Dentistry 1223G0001X Primary
Pediatric Dentistry 1223P0221X
Prosthodontics 1223P0700X

Addresses

Primary practice location

30 Central Park S RM 11C
New York, NY 10019-1628

Mailing address

30 Central Park S RM 11C
New York, NY 10019-1628
Phone (212) 702-8675

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1742169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743120000000",
    "number": "1720888910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 CENTRAL PARK S RM 11C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191628",
            "telephone_number": "212-702-8675",
            "fax_number": "212-702-8675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 CENTRAL PARK S RM 11C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191628",
            "telephone_number": "212-702-8675",
            "fax_number": "212-702-8675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANHATTAN PARK DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-17",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A",
        "authorized_official_last_name": "SAN MIGUEL",
        "authorized_official_first_name": "CAMILLE",
        "authorized_official_middle_name": "SUZETTE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "240-491-7171",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2025; 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.