OAKDALE MALL DENTAL LLP (NPI# 1801156674) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801156674 |
| Entity Type | Organization |
| Organization Name | OAKDALE MALL DENTAL LLP |
| Practice Address |
601-635 Harry L Dr 46 Johnson City NY 13790-1246 |
| Practice Telephone | 6077708888 |
| Practice Fax Number | 6077708881 |
| Mailing Telephone | 6077708888 |
| Mailing Fax Number | 6077708881 |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2012-05-25 |
| Authorized Official Name | ROSS KRASNOV (OWNER) |
| Authorized Official Telephone | 6077708888 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 046043 | NY | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 01580001 | 05 |
| Street Address |
601-635 HARRY L DR 46 |
| City | JOHNSON CITY |
| State | NY |
| Zip Code | 13790-1246 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346397635 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 601-635 Harry L Dr, Oakdale Mall, Johnson City, NY 13790-1246 | 2007-01-05 |
| 1265641328 | Viengsamay J Chamleunsouk | Technician/Technologist | 601-635 Harry L Dr, Sterling Optical, Johnson City, NY 13790 | 2007-05-22 |
| 1649313867 | Gerald Donald Prudhomme | Optometrist | 601-635 Harry L Dr, Suite 55, Johnson City, NY 13790-1246 | 2007-02-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578107645 | Thomas William Sorber | Occupational Therapist | 33 Harrison St, Johnson City, Johnson City, NY 13790 | 2019-11-01 |
| 1326534116 | Silver Linings Golden Memory Care | Clinic/Center | 4416 Watson Blvd, Johnson City, NY 13790 | 2018-07-05 |
| 1508308545 | Irene Mukeli Nzasi | Registered Nurse | 156 Corliss Ave Suite 107, Johnson City, NY 13790 | 2016-11-08 |
| 1053867754 | Tabitha Rae Toman | Physical Therapist | 34 Harrison St, Johnson City, NY 13790 | 2016-09-01 |
| 1235685066 | Dianne Brunner | Physical Therapist | 33-55 Harrison Street, Wilson Hospital, Johnson City, NY 13790 | 2016-08-31 |
| 1578982682 | Tracy Lynn Brown | Optometrist | 223 Reynolds Road, Johnson City, NY 13790 | 2014-04-16 |
| 1083041495 | Maryann Serbonich | Pharmacist | 52 Harrison Street, Johnson City, NY 13790 | 2013-09-30 |
| 1134464399 | Kasey Connor Folger | Speech-Language Pathologist | 3 Laurel St., Johnson City, NY 13790 | 2012-11-29 |
| 1467797571 | Bodyworks Physical Therapy LLC | Clinic/Center | 765 Harry L Drive, Johnson City, NY 13790 | 2012-11-29 |
| 1548518400 | Melissa L Korosec | Nurse Practitioner | 30 Harrison St., Suite 250, Johnson City, NY 13790 | 2012-08-27 |
| Find all providers in zip 13790 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154980217 | Michael Ryan Fuchs | Dentist | 508 Princeton Rd Ste 101, Johnson City, TN 37601-2060 | 2019-06-11 |
| 1437658507 | Advanced Dental and Anesthesia Solutions LLC | Dentist | 135 Marketplace Dr Ste 101, Johnson City, TN 37604-8933 | 2018-02-05 |
| 1366996084 | Amy Herron Moody | Dentist | 108 W 10th Ave, Johnson City, TN 37604-3800 | 2016-08-10 |
| 1205063203 | Phung Pham Johnson | Dentist | 520 W Oakland Ave, Suite 6, Johnson City, TN 37604-1654 | 2009-06-17 |
| 1053552307 | Allcare Dental & Dentures | Dentist | 2301 N Roan St, Johnson City, TN 37601-1701 | 2009-03-17 |
| 1679767669 | Thomas Russell Seaver | Dentist | 401 W Walnut St, Johnson City, TN 37604-6713 | 2007-09-01 |
| 1578761953 | William Thomas Baker Jr. | Dentist | 300 West Watauga Avenue, Johnson City, TN 37604 | 2007-07-06 |
| 1912115866 | Hugh Charles Mohler | Dentist | 513 E Unaka Ave, Johnson City, TN 37601-4032 | 2007-05-21 |
| 1891816534 | Walter Jeff Banyas | Dentist | 216 W Watauga Ave, Johnson City, TN 37604-5624 | 2007-04-02 |
| 1306981915 | Lester G Koe Jr. | Dentist | 106 East Unaka Ave, Johnson City, TN 37601-4624 | 2007-02-21 |
| Find all providers in JOHNSON CITY | ||||
| City | JOHNSON CITY |
| Zip Code | 13790 |
Please comment or provide details below to improve the information on OAKDALE MALL DENTAL LLP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.