NPIMap

Organization Active NPI

Davis Square Dental Specialists

  • Dentist
  • Dorchester, MA
National Provider Identifier
1013258359
Registry record updated Mar 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
20416 Issued in MA
Legal business name
DAVIS SQUARE DENTAL SPECIALISTS
Practice address
1792 Dorchester Ave
Dorchester, MA 02124-2533
Phone
(617) 265-8338
NPI assigned
Mar 12, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2013

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

Authorized official

Name
Dr. Mouhab Z Rizkallah
Title
Owner
Phone
(617) 764-2247

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 20416 MA Primary

Addresses

Primary practice location

1792 Dorchester Ave
Dorchester, MA 02124-2533

Mailing address

30 College Ave
Somerville, MA 02144-1914

National Provider Directory

National Provider Directory
Tax ID family
Davis Square Dental Group6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

1792 Dorchester Ave
Dorchester, MA 02124
Phone (617) 265-8338

NPI Registry JSON

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

{
    "created_epoch": "1363046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363046400000",
    "number": "1013258359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 COLLEGE AVE",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021441914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1792 DORCHESTER AVE",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021242533",
            "telephone_number": "617-265-8338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVIS SQUARE DENTAL SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-12",
        "last_updated": "2013-03-12",
        "status": "A",
        "authorized_official_last_name": "RIZKALLAH",
        "authorized_official_first_name": "MOUHAB",
        "authorized_official_middle_name": "Z",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-764-2247",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "20416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dorchester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2013; 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.