Active NPI
Consuelo Trinidad Poveda, DDS
- Dentist
- Jackson Heights, NY
National Provider Identifier
1942308366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 045030-1
- Practice address
- 3721 75TH St
Jackson Heights, NY 11372-6405 - Phone
- (718) 476-3800
- Fax
- (718) 533-7808
- NPI assigned
- Sep 20, 2006
- Last updated
- Oct 14, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 045030-1 | NY | Primary |
Addresses
Primary practice location
3721 75TH St
Jackson Heights, NY 11372-6405
Mailing address
3742 90TH St
Jackson Heights, NY 11372-7830
Phone (718) 424-5559
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 045030-1 | NY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centro Dental Familiar P.C | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602633600000",
"number": "1942308366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3742 90TH ST",
"city": "JACKSON HEIGHTS",
"state": "NY",
"postal_code": "113727830",
"telephone_number": "718-424-5559",
"fax_number": "718-426-2428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3721 75TH ST",
"city": "JACKSON HEIGHTS",
"state": "NY",
"postal_code": "113726405",
"telephone_number": "718-476-3800",
"fax_number": "718-533-7808"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POVEDA",
"first_name": "CONSUELO",
"middle_name": "TRINIDAD",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2020-10-14",
"certification_date": "2020-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "045030-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson Heights, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 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.