NPIMap

Organization Active NPI

St.Joseph'S Family Dental,LLC

  • Dentist
  • West Springfield, MA
National Provider Identifier
1003143157
Registry record updated Nov 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
21492 Issued in MA
Legal business name
ST.JOSEPH'S FAMILY DENTAL,LLC
Practice address
258 Main St
West Springfield, MA 01089-3955
Phone
(413) 737-3181
Fax
(413) 737-3184
NPI assigned
Nov 11, 2009
Organization subpart
Yes
Parent organization
ST.JOSEPH'S FAMILY DENTAL,LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 11, 2009

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

Authorized official

Name
Dr. Susana R Aguero, D.D.S.
Title
Dentist
Phone
(413) 737-3181

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 21492 MA Primary

Addresses

Primary practice location

258 Main St
West Springfield, MA 01089-3955

Mailing address

258 Main St
West Springfield, MA 01089-3955
Phone (413) 737-3181

Other identifiers 1

IdentifierTypeStateIssuer
110076716BMedicaidMA

National Provider Directory

National Provider Directory
Tax ID family
St Joseph'S Family Dental3 organizations share this tax ID, including this one
Part of
St Joseph'S Family Dental

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1257897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257897600000",
    "number": "1003143157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "258 MAIN ST",
            "city": "WEST SPRINGFIELD",
            "state": "MA",
            "postal_code": "010893955",
            "telephone_number": "413-737-3181",
            "fax_number": "413-737-3184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "258 MAIN ST",
            "city": "WEST SPRINGFIELD",
            "state": "MA",
            "postal_code": "010893955",
            "telephone_number": "413-737-3181",
            "fax_number": "413-737-3184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST.JOSEPH'S FAMILY DENTAL,LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST.JOSEPH'S FAMILY DENTAL,LLC",
        "enumeration_date": "2009-11-11",
        "last_updated": "2009-11-11",
        "status": "A",
        "authorized_official_last_name": "AGUERO",
        "authorized_official_first_name": "SUSANA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "413-737-3181",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "21492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110076716B",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Springfield, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2009; 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.