Oakdale Mall Dental LLP

Primary specialty

DentistTaxonomy code 122300000X

License

046043 Issued in NY

Legal business name

OAKDALE MALL DENTAL LLP

Practice address

601-635 Harry L Dr
46
Johnson City, NY 13790-1246

Phone

(607) 770-8888

Fax

(607) 770-8881

NPI assigned

May 25, 2012

Last updated

May 25, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ross Krasnov, DDS

Title

Owner

Phone

(607) 770-8888

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1337904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337904000000",
    "number": "1801156674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601-635 HARRY L DR",
            "address_2": "46",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137901246",
            "telephone_number": "607-770-8888",
            "fax_number": "607-770-8881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601-635 HARRY L DR",
            "address_2": "46",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137901246",
            "telephone_number": "607-770-8888",
            "fax_number": "607-770-8881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAKDALE MALL DENTAL LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-25",
        "last_updated": "2012-05-25",
        "status": "A",
        "authorized_official_last_name": "KRASNOV",
        "authorized_official_first_name": "ROSS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "607-770-8888",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "046043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01580001",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Elizabeth Notchick, PA
• Kara Ann Nunn, M.S., CCC-SLP
• Irene Mukeli Nzasi, CRNA
• Paige Marie O'Neil, MS, RDN, LDN, CNSC
• Shane R O'Neil, PA
• Oakdale Psychology Associates
• Michal Obrzut, MD
• Peter Babatunde Ojo, M.D
• Sean Okeefe
• Tracy E Olevano, MS ED.

• Dentist in Johnson City, NY
• Providers in Johnson City, 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 25, 2012; 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.