Jacob Alayev Avner, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

049689 Issued in NY

Practice address

9725 64TH Ave Ste G3
Rego Park, NY 11374-2205

Phone

(718) 275-7300

Fax

(718) 275-7307

NPI assigned

Feb 15, 2007

Last updated

Dec 5, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jacob a. Avner, DDS PC

  dba Great Smiles of NY

  • General Practice Dentistry
  • Rego Park, NY
  • NPI 1114398807
  NPD (past) Authorized official

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386201600000",
    "number": "1851434021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9725 64TH AVE STE G3",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113742205",
            "telephone_number": "718-275-7300",
            "fax_number": "718-275-7307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9725 64TH AVE STE G3",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113742205",
            "telephone_number": "718-275-7300",
            "fax_number": "718-275-7307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVNER",
        "first_name": "JACOB",
        "middle_name": "ALAYEV",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2013-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "049689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02282222",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adel Avezoff, FNP
• Ema Avezova
• Michael Aviel, DDS
• Nathalie Avignon
• Zhanna Avizov, DPT
• Avs Medical Supply, Inc.
• Roman Aykelinchayev, PA-C
• Mariam Azimi, PHARMD
• Simab Aziz
• Melissa Azzopardi

• General Practice Dentistry in Rego Park, NY
• Providers in Rego Park, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2013; 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.