Individual provider Active NPI

David Robert Kissell, DMD

  • General Practice Dentistry
  • Westwood, MA
National Provider Identifier
1023169364
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
19477 Issued in MA
Practice address
541 High St
Westwood, MA 02090-1628
Phone
(781) 320-0300
Fax
(781) 320-8637
NPI assigned
Jan 15, 2007
Sex
Male
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 19477 MA Primary

Addresses

Primary practice location

541 High St
Westwood, MA 02090-1628

Mailing address

541 High St
Westwood, MA 02090-1628
Phone (781) 320-0300

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
I20150327000740 MA Order and Referring Only - DentistPractitioner - Dentist 9133446321

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
19477MAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1023169364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 HIGH ST",
            "city": "WESTWOOD",
            "state": "MA",
            "postal_code": "020901628",
            "telephone_number": "781-320-0300",
            "fax_number": "781-320-8637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 HIGH ST",
            "city": "WESTWOOD",
            "state": "MA",
            "postal_code": "020901628",
            "telephone_number": "781-320-0300",
            "fax_number": "781-320-8637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISSELL",
        "first_name": "DAVID",
        "middle_name": "ROBERT",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "19477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westwood, MA

Sources for this page

Verify at the official NPI Registry.