NPIMap

Organization Active NPI

Concorddental Implants &Periodontics

  • Periodontics
  • Concord, MA
National Provider Identifier
1063732477
Registry record updated Jun 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
18710 Issued in MA
Legal business name
CONCORDDENTAL IMPLANTS &PERIODONTICS
Practice address
290 Baker Ave
S205
Concord, MA 01742-2189
Phone
(978) 369-4611
Fax
(978) 369-4622
NPI assigned
Jun 8, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2010

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

Authorized official

Name
Dr. Mark Y. Wang, DMD
Title
President
Phone
(978) 369-4611

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 18710 MA Primary

Addresses

Primary practice location

290 Baker Ave
S205
Concord, MA 01742-2189

Mailing address

290 Baker Ave
Suite205
Concord, MA 01742-2189
Phone (978) 369-4611

National Provider Directory

National Provider Directory

Locations

290 Baker Ave
Ste S205
Concord, MA 01742
Phone (978) 369-4611

290 Baker Ave
Ste 205
Concord, MA 01742

NPI Registry JSON

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

{
    "created_epoch": "1275955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275955200000",
    "number": "1063732477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 BAKER AVE",
            "address_2": "SUITE205",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017422189",
            "telephone_number": "978-369-4611",
            "fax_number": "978-369-4622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 BAKER AVE",
            "address_2": "S205",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017422189",
            "telephone_number": "978-369-4611",
            "fax_number": "978-369-4622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCORDDENTAL IMPLANTS &PERIODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-08",
        "last_updated": "2010-06-08",
        "status": "A",
        "authorized_official_last_name": "WANG",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "Y.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "978-369-4611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MA",
            "license": "18710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2010; 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.