NPIMap

Organization Active NPI

Countryside Dental

  • General Practice Dentistry
  • Chatham, NY
National Provider Identifier
1952558074
Registry record updated Aug 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
045941 Issued in NY
Legal business name
COUNTRYSIDE DENTAL
Practice address
42 Kinderhook St
Chatham, NY 12037-1207
Phone
(518) 392-5231
Fax
(518) 392-7339
NPI assigned
Aug 20, 2008
Last updated
Aug 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2008

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

Authorized official

Name
Dr. Domenic Riccobono, DDSNPI 1578677175
Title
Owner
Phone
(518) 392-5231

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 045941 NY Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 039271 NY

Addresses

Primary practice location

42 Kinderhook St
Chatham, NY 12037-1207

Mailing address

42 Kinderhook St
Chatham, NY 12037-1207
Phone (518) 392-5231

National Provider Directory

National Provider Directory

Locations

42 Kinderhook St
Chatham, NY 12037
Phone (518) 392-5231

Practitioners & affiliated clinicians

Practitioners 1

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": "1219190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219190400000",
    "number": "1952558074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 KINDERHOOK ST",
            "city": "CHATHAM",
            "state": "NY",
            "postal_code": "120371207",
            "telephone_number": "518-392-5231",
            "fax_number": "518-392-7339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 KINDERHOOK ST",
            "city": "CHATHAM",
            "state": "NY",
            "postal_code": "120371207",
            "telephone_number": "518-392-5231",
            "fax_number": "518-392-7339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-20",
        "last_updated": "2008-08-20",
        "status": "A",
        "authorized_official_last_name": "RICCOBONO",
        "authorized_official_first_name": "DOMENIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "518-392-5231",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "045941",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "039271",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chatham, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2008; 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.