NPIMap

Organization Active NPI

Cedar Brook Pediatric Dentistry PLLC

  • Pediatric Dentistry
  • Southborough, MA
National Provider Identifier
1003579277
Registry record updated Oct 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
CEDAR BROOK PEDIATRIC DENTISTRY PLLC
Practice address
162 Cordaville Rd Ste 175
Southborough, MA 01772-1838
Phone
(617) 817-6346
NPI assigned
Oct 14, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2021

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

Authorized official

Name
Dr. Naomi La, DMDNPI 1285087999
Title
Practice Owner
Phone
(617) 817-6346

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

162 Cordaville Rd Ste 175
Southborough, MA 01772-1838

Mailing address

302 Bay Dr
Northborough, MA 01532-3403

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1634169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634169600000",
    "number": "1003579277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 BAY DR",
            "city": "NORTHBOROUGH",
            "state": "MA",
            "postal_code": "015323403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "162 CORDAVILLE RD STE 175",
            "city": "SOUTHBOROUGH",
            "state": "MA",
            "postal_code": "017721838",
            "telephone_number": "617-817-6346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR BROOK PEDIATRIC DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-14",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "status": "A",
        "authorized_official_last_name": "LA",
        "authorized_official_first_name": "NAOMI",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "617-817-6346",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southborough, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2021; 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.