Kristen Brocavich, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

061138 Issued in NY

Practice address

150 Islip Ave Ste 11
Islip, NY 11751-3222

Phone

(631) 581-3100

NPI assigned

Aug 4, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Kathleen M. Frost, DDS PC

  • Periodontics
  • Islip, NY
  • NPI 1619566718
  NPD

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

{
    "created_epoch": "1596499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596499200000",
    "number": "1851901896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 FARNUM ST",
            "city": "LYNBROOK",
            "state": "NY",
            "postal_code": "115633920",
            "telephone_number": "516-993-8731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 ISLIP AVE STE 11",
            "city": "ISLIP",
            "state": "NY",
            "postal_code": "117513222",
            "telephone_number": "631-581-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCAVICH",
        "first_name": "KRISTEN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-04",
        "last_updated": "2020-08-04",
        "certification_date": "2020-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NY",
            "license": "061138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Brandt, MS, ATC, PES
• Karlene Elizabeth Braun-Oscher, P.T.
• Bridget Mary Breen, LMHC
• Kristen A Brelsford, SLP
• Christine Breslin
• Neil Burton, CASAC
• Avraham Calev, PH.D.
• Fatima Maribel Calle, LMSW
• Elizabeth P Camera
• Theresa Campbell, PMHNP- BC

• Periodontics in Islip, NY
• Providers in Islip, NY by specialty
• Periodontics in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 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.