NPIMap

Organization Active NPI

My Dental Revere PC

  • Dentist
  • Saugus, MA
National Provider Identifier
1053765412
Registry record updated Apr 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN22184 Issued in MA
Legal business name
MY DENTAL REVERE PC
Practice address
1401 Rock Wood Dr
Saugus, MA 01906-4537
Phone
(740) 215-8549
NPI assigned
Apr 21, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2016

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

Authorized official

Name
Srinivas Desaneedi, DMDNPI 1023271590
Title
Owner
Phone
(740) 215-8549

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DN22184 MA Primary

Addresses

Primary practice location

1401 Rock Wood Dr
Saugus, MA 01906-4537

Mailing address

1401 Rock Wood Dr
Saugus, MA 01906-4537

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1461196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461196800000",
    "number": "1053765412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 ROCK WOOD DR",
            "city": "SAUGUS",
            "state": "MA",
            "postal_code": "019064537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 ROCK WOOD DR",
            "city": "SAUGUS",
            "state": "MA",
            "postal_code": "019064537",
            "telephone_number": "740-215-8549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY DENTAL REVERE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-21",
        "last_updated": "2016-04-21",
        "status": "A",
        "authorized_official_last_name": "DESANEEDI",
        "authorized_official_first_name": "SRINIVAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "740-215-8549",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN22184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saugus, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2016; 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.