Eastside Family Dental of Fairport, PC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

EASTSIDE FAMILY DENTAL OF FAIRPORT, PC

Practice address

302 Cross Keys Office Park
Fairport, NY 14450-3511

Phone

(585) 223-5010

NPI assigned

May 14, 2021

Organization subpart

No

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

Authorized official

Name

Jennifer Altobelli

Title

Office Manager

Phone

(585) 223-5010

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa G Marin, DMD, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Augusta, GA
  • NPI 1578659967
  NPD (past)

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

{
    "created_epoch": "1620950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620950400000",
    "number": "1891369799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 CROSS KEYS OFFICE PARK",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144503511",
            "telephone_number": "585-223-5010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 CROSS KEYS OFFICE PARK",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144503511",
            "telephone_number": "585-223-5010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1136 NY-318",
            "address_purpose": "LOCATION",
            "city": "Waterloo",
            "state": "NY",
            "postal_code": "13165",
            "country_code": "US",
            "telephone_number": "315-539-5020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EASTSIDE FAMILY DENTAL OF FAIRPORT, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-14",
        "last_updated": "2021-05-14",
        "certification_date": "2021-04-15",
        "status": "A",
        "authorized_official_last_name": "ALTOBELLI",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "585-223-5010"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1851482988",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@eastsidesmile.com",
            "affiliation": "N",
            "endpointDescription": "General email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "302 Cross Keys Office Park",
            "city": "Fairport",
            "state": "NY",
            "country_code": "US",
            "postal_code": "144503511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Robert E Dupre, DMD
• Deborah S Dutko, R.N.
• Nadezhda I Dyakiv, RN
• Early Opportunities With Language and Speech (Early O.W.L.S.)
• East Ridge Hearing & Speech Center, Inc
• Eastside Pediatrics, PLLC
• Eastside Podiatry
• Elsbeth Ebenhoe, LCSW
• Eckerd Corporation
• Benjamin Thomas Eckler

• Pediatric Dentistry in Fairport, NY
• Providers in Fairport, NY by specialty
• Pediatric Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2021; 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.