NPIMap

Organization Active NPI

Somerville Dentistry and Braces, P.C.

  • General Practice Dentistry
  • Somerville, MA
National Provider Identifier
1053893115
Registry record updated Sep 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN20209 Issued in MA
Legal business name
SOMERVILLE DENTISTRY AND BRACES, P.C.
Practice address
5 Middlesex Ave Ste 305
Somerville, MA 02145-1110
Phone
(508) 872-3072
NPI assigned
Sep 5, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2018

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

Authorized official

Name
Joanne Tavano
Title
Cfo
Phone
(978) 580-1524

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X DN20209 MA Primary

Addresses

Primary practice location

5 Middlesex Ave Ste 305
Somerville, MA 02145-1110

Mailing address

5 Mount Royal Ave Ste 300
Marlborough, MA 01752-1900
Phone (508) 723-0725

Other identifiers 1

IdentifierTypeStateIssuer
DN20209OtherMASTATE LICENSE

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1536105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536105600000",
    "number": "1053893115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 MOUNT ROYAL AVE STE 300",
            "city": "MARLBOROUGH",
            "state": "MA",
            "postal_code": "017521900",
            "telephone_number": "508-723-0725",
            "fax_number": "508-872-0781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 MIDDLESEX AVE STE 305",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021451110",
            "telephone_number": "508-872-3072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOMERVILLE DENTISTRY AND BRACES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-05",
        "last_updated": "2018-09-05",
        "status": "A",
        "authorized_official_last_name": "TAVANO",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "978-580-1524"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN20209",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "DN20209",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Somerville, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2018; 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.