Individual provider Active NPI

Tacuhi Sona Tacvorian, DMD

  • General Practice Dentistry
  • Waltham, MA
National Provider Identifier
1023101300
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
18257 Issued in MA
Practice address
24 Crescent St
# 302
Waltham, MA 02453-4358
Phone
(781) 899-8174
NPI assigned
Oct 1, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 18257 MA Primary

Addresses

Primary practice location

24 Crescent St
# 302
Waltham, MA 02453-4358

Mailing address

24 Crescent St
# 302
Waltham, MA 02453-4358
Phone (781) 899-8174

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150417000812 MA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 9032437355

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18257MAMDContractor

NPI Registry JSON

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

{
    "created_epoch": "1159660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1023101300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 CRESCENT ST",
            "address_2": "# 302",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024534358",
            "telephone_number": "781-899-8174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 CRESCENT ST",
            "address_2": "# 302",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024534358",
            "telephone_number": "781-899-8174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACVORIAN",
        "first_name": "TACUHI",
        "middle_name": "SONA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "18257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waltham, MA

Sources for this page

Verify at the official NPI Registry.