Prospect Dental Care

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PROSPECT DENTAL CARE

Practice address

145 Prospect St Ste 202
Ridgewood, NJ 07450-4493

Phone

(201) 444-9011

Fax

(201) 857-4676

NPI assigned

Apr 29, 2019

Organization subpart

No

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

Authorized official

Name

Dr. John Makhoul, DDS

Title

Owner

Phone

(201) 444-9011

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1556496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556496000000",
    "number": "1750945473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 PROSPECT ST STE 202",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074504493",
            "telephone_number": "201-444-9011",
            "fax_number": "201-857-4676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 PROSPECT ST STE 202",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074504493",
            "telephone_number": "201-444-9011",
            "fax_number": "201-857-4676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPECT DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-29",
        "last_updated": "2019-04-29",
        "status": "A",
        "authorized_official_last_name": "MAKHOUL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-444-9011",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2019; 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.