Wading River Pediatric Dentistry, PC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

WADING RIVER PEDIATRIC DENTISTRY, PC

Practice address

6336 Route 25a
Wading River, NY 11792-2030

Phone

(516) 524-6756

NPI assigned

Feb 24, 2020

Organization subpart

No

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

Authorized official

Name

Jeffrey Campisi, DDSNPI 1457499162

Title

President

Phone

(516) 524-6756

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeffrey P Campisi, DDS

  • Pediatric Dentistry
  • Wading River, NY
  • NPI 1457499162
  NPD Authorized official

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

{
    "created_epoch": "1582502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582502400000",
    "number": "1750915377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6336 ROUTE 25A",
            "city": "WADING RIVER",
            "state": "NY",
            "postal_code": "117922030",
            "telephone_number": "516-524-6756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6336 ROUTE 25A",
            "city": "WADING RIVER",
            "state": "NY",
            "postal_code": "117922030",
            "telephone_number": "516-524-6756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WADING RIVER PEDIATRIC DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-24",
        "last_updated": "2020-02-24",
        "certification_date": "2020-02-24",
        "status": "A",
        "authorized_official_last_name": "CAMPISI",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-524-6756",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corinne Brooke Vidulich, M.D.
• Kim Ann Vitacco, NP
• Wading River Complete Dental Care PC
• Wading River Fire District
• Wading River Medical Care PC
• Wading River Physical Therapy, PC
• Jeffrey Todd Wagner, PT, DPT
• Walgreen Co
• Denise Joanne Weber, R.PH
• Natalie Marie Wend, DC

• Pediatric Dentistry in Wading River, NY
• Providers in Wading River, 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 Feb 24, 2020; 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.