Fourth Avenue Dental

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

FOURTH AVENUE DENTAL

Practice address

5404 4TH Ave
Brooklyn, NY 11220-3006

Phone

(718) 439-2876

Fax

(718) 439-2879

NPI assigned

Mar 23, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Andrew Maron, DMD

Title

Dentist

Phone

(718) 439-2876

Specialties & licenses 2

Addresses

Other identifiers 1

Tax ID family

4TH Avenue Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• 4TH Avenue Dental

  • General Practice Dentistry
  • Brooklyn, NY
  • NPI 1295009447
  NPD tax ID

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

{
    "created_epoch": "1300838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344297600000",
    "number": "1881993392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5404 4TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112203006",
            "telephone_number": "718-439-2876",
            "fax_number": "718-439-2879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5404 4TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112203006",
            "telephone_number": "718-439-2876",
            "fax_number": "718-439-2879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOURTH AVENUE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-23",
        "last_updated": "2012-08-07",
        "status": "A",
        "authorized_official_last_name": "MARON",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "718-439-2876",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03170656",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Samy Fourati, M.D.
• Sabrina Gabrielle Fourcand, R.N.
• Patrice Ananie Fouron, DO
• Aboudlrachid Fousseni
• Tsabikos Foutoulis, PHARM.D
• Fouzia Syed Physician PLLC
• Fouzia Syed Physician PLLC
• Karene Fowler, MSW

• Oral and Maxillofacial Surgery (Dentist) in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.