Southwoods Boulevard Dental, P.C.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

SOUTHWOODS BOULEVARD DENTAL, P.C.

Doing business as

Capital District Oral & Maxillofacial Surgeons

Practice address

7 Southwoods Blvd Ste 1
Albany, NY 12211-2526

Phone

(518) 445-2505

NPI assigned

Aug 27, 2019

Organization subpart

Yes

Parent organization

SOUTHWOODS BOULEVARD DENTAL, P.C.As reported in NPPES

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

Authorized official

Name

Leah Ann Maylott

Title

Credentialing Administrator

Phone

(860) 874-8198

Specialties & licenses 1

Addresses

Other names 1

• Capital District Oral & Maxillofacial Surgeons Doing business as

Part of

Southwoods Boulevard Dental

Locations

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

{
    "created_epoch": "1566864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641772800000",
    "number": "1730737545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 WHITNEY AVE STE 740",
            "city": "HOLYOKE",
            "state": "MA",
            "postal_code": "010402789",
            "telephone_number": "413-382-7022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 SOUTHWOODS BLVD STE 1",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122112526",
            "telephone_number": "518-445-2505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWOODS BOULEVARD DENTAL, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHWOODS BOULEVARD DENTAL, P.C.",
        "enumeration_date": "2019-08-27",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A",
        "authorized_official_last_name": "MAYLOTT",
        "authorized_official_first_name": "LEAH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CREDENTIALING ADMINISTRATOR",
        "authorized_official_telephone_number": "860-874-8198"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Capital District Oral & Maxillofacial Surgeons",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Capital District Oral & Maxillofacial Surgeons",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Winell Jenetta Soures, LCSW-R, SAP, MSW,MA
• Karen Sousis, LPN
• Kristina Sousou, DO
• South Colonie Central Schools
• South Colonie High School
• Bruno Souza Di Nucci, DO
• Sow Seed Mental Health Counseling, PLLC
• Sowania Germain LMHC PLLC
• Jessica Spadola
• Kiersten Spagli, MHC

• Oral and Maxillofacial Surgery (Dentist) in Albany, NY
• Providers in Albany, 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 Jan 10, 2022; 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.