Lia Datikashvili, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

055422-1 Issued in NY

Practice address

293 E 149TH St
Bronx, NY 10451-5601

Phone

(646) 404-5005

NPI assigned

May 20, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1305849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305849600000",
    "number": "1780977926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "293 E 149TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104515601",
            "telephone_number": "646-404-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "293 E 149TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104515601",
            "telephone_number": "646-404-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DATIKASHVILI",
        "first_name": "LIA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-20",
        "last_updated": "2011-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "055422-1",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02125000",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rodrigo M Dasilva, LMSW
• Dina Dass, MD
• Gabriel L. Dassa, D.O.
• Dat Radio Dispatcher Inc
• Dat Transportation Inc
• Arpita Datta, M.D.
• Jocelyn Gina Marie Daubendiek
• Leonard Gene Dauber, MD
• Marcus Vincent Daugherty, M.A., LMHC
• Daughters of Jacob Adult Day Care Program

• Dentist in Bronx, NY
• Providers in Bronx, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.