NPIMap

Organization Active NPI

Marusich & Conti Dental, PLLC

Doing business as Columbia Dental Group

  • General Practice Dentistry
  • Johnson City, NY
National Provider Identifier
1891825600
Registry record updated Apr 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
041409 Issued in NY
Legal business name
MARUSICH & CONTI DENTAL, PLLC
Doing business as
Columbia Dental Group
Practice address
515 Columbia Drive
Johnson City, NY 13790
Phone
(607) 770-1122
Fax
(607) 770-1176
NPI assigned
Mar 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2021

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

Authorized official

Name
Dr. Roger Antonio Conti, D.D.S.NPI 1063534584
Title
Partner
Phone
(607) 770-1122

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 041409 NY Primary

Addresses

Primary practice location

515 Columbia Drive
Johnson City, NY 13790

Mailing address

515 Columbia Drive
Johnson City, NY 13790
Phone (607) 770-1122

Other identifiers 1

IdentifierTypeStateIssuer
104448556MedicaidNY

Other names 1

  • Columbia Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

515 Columbia Dr
Johnson City, NY 13790
Phone (607) 770-1122

190 Main St
Johnson City, NY 13790
Phone (607) 797-1310

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619740800000",
    "number": "1891825600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 COLUMBIA DRIVE",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "13790",
            "telephone_number": "607-770-1122",
            "fax_number": "607-770-1176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 COLUMBIA DRIVE",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "13790",
            "telephone_number": "607-770-1122",
            "fax_number": "607-770-1176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARUSICH & CONTI DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2021-04-30",
        "certification_date": "2021-04-30",
        "status": "A",
        "authorized_official_last_name": "CONTI",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "ANTONIO",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "607-770-1122",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "041409",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104448556",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Columbia Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johnson City, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 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.