125TH Street Dental LLP

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

049097 Issued in NY

Legal business name

125TH STREET DENTAL LLP

Practice address

437 W 125TH St
New York, NY 10027-4201

Phone

(646) 827-9819

Fax

(646) 827-0510

NPI assigned

Mar 9, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Serguei Kopetskov, DDS

Title

President

Phone

(646) 827-9819

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861523771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "437 W 125TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100274201",
            "telephone_number": "646-827-9819",
            "fax_number": "646-827-0510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "437 W 125TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100274201",
            "telephone_number": "646-827-9819",
            "fax_number": "646-827-0510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "125TH STREET DENTAL LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KOPETSKOV",
        "authorized_official_first_name": "SERGUEI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "646-827-9819",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "049097",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02772787",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 121 Care LLC
• 123 Dental Group PC
• 123 Medical Group, P.C.
• 125TH St. Dental Group, PLLC
• 125TH Street Dental Arts P.C.
• 125TH Street Orthodontics, PC
• 128 Central Park South Physicians PLLC
• 128 Plastic Surgery Associates PLLC
• 12TH Street Dental PLLC
• 1317 Medical, P.C.

• General Practice Dentistry in New York, NY
• Providers in New York, 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 Aug 22, 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.