Individual provider Active NPI

Stuart J. Macdonald, D.M.D.

  • General Practice Dentistry
  • Hyde Park, MA
National Provider Identifier
1023134137
Registry record updated May 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
20284 Issued in MA
Practice address
1259 Hyde Park Ave
Hyde Park, MA 02136-2817
Phone
(617) 364-5500
Fax
(617) 361-1351
NPI assigned
Mar 21, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2016

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 20284 MA Primary

Addresses

Primary practice location

1259 Hyde Park Ave
Hyde Park, MA 02136-2817

Mailing address

195 Tower St
Dedham, MA 02026-3801
Phone (781) 381-0267

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160601000470 MA Order and Referring Only - Other (Non-Physician) 5890085039

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462492800000",
    "number": "1023134137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 TOWER ST",
            "city": "DEDHAM",
            "state": "MA",
            "postal_code": "020263801",
            "telephone_number": "781-381-0267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1259 HYDE PARK AVE",
            "city": "HYDE PARK",
            "state": "MA",
            "postal_code": "021362817",
            "telephone_number": "617-364-5500",
            "fax_number": "617-361-1351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACDONALD",
        "first_name": "STUART",
        "middle_name": "J.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2016-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "20284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hyde Park, MA

Sources for this page

Verify at the official NPI Registry.