Revere Dental and Orthodontics PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

REVERE DENTAL AND ORTHODONTICS PC

Practice address

123 Revere St
Revere, MA 02151-4439

Phone

(617) 275-6306

NPI assigned

Dec 29, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Neetu Bansal, DMD

Title

Owner

Phone

(617) 275-6306

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1703808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703808000000",
    "number": "1053180208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 BRIGHTON ST APT 3",
            "city": "CHARLESTOWN",
            "state": "MA",
            "postal_code": "021291260",
            "telephone_number": "617-275-6306",
            "fax_number": "617-997-0030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 REVERE ST",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021514439",
            "telephone_number": "617-275-6306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVERE DENTAL AND ORTHODONTICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-29",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A",
        "authorized_official_last_name": "BANSAL",
        "authorized_official_first_name": "NEETU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-275-6306",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elna Raymond
• Kevin Stewart Reddall
• Misael Oliveira Rehbain
• Rettoc Optical Service
• Revere Adult Day Health Care
• Revere Dentistry and Braces LLC
• Revere Health Center Pharmacy
• Revere Homecare Services
• Revere Pediatric Dentistry
• Revere Physical Therapy

• General Practice Dentistry in Revere, MA
• Providers in Revere, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2023; 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.