Parkside Dental PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

049097 Issued in NY

Legal business name

PARKSIDE DENTAL PC

Practice address

325 Ocean Ave
Brooklyn, NY 11225

Phone

(718) 462-7436

Fax

(718) 462-2418

NPI assigned

Sep 26, 2006

Last updated

Jun 7, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Serge Kupetz, DDS

Title

Doctor Owner

Phone

(718) 462-7436

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370563200000",
    "number": "1902907744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 OCEAN AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11225",
            "telephone_number": "718-462-7436",
            "fax_number": "718-462-2418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 OCEAN AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11225",
            "telephone_number": "718-462-7436",
            "fax_number": "718-462-2418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKSIDE DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2013-06-07",
        "status": "A",
        "authorized_official_last_name": "KUPETZ",
        "authorized_official_first_name": "SERGE",
        "authorized_official_title_or_position": "DOCTOR OWNER",
        "authorized_official_telephone_number": "718-462-7436",
        "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": "02119991",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Parkshore Health Care LLC (Four Seasons Nrs & Reh Ctr ADHC)
• Parkshore Healthcare LLC
• Parkshore Healthcare LLC (Four Seasons Nursing & Rehabilitation Center)
• Parkshore Home Health Care LLC (Renaissance Home Health Care)
• Parkside Dental PC
• Parkside Express Pharmacy, Inc.
• Parkside Medical Office, PLLC
• Parkside Medical Services PC
• Parkslope Eye Care, Inc
• Parkslope Eye Studio, Inc.

• General Practice Dentistry in Brooklyn, NY
• Providers in Brooklyn, 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 Jun 7, 2013; 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.