NPIMap

Organization Active NPI

Back Bay Dental Group LLC

  • Dentist
  • Boston, MA
National Provider Identifier
1063758639
Registry record updated Jan 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
BACK BAY DENTAL GROUP LLC
Practice address
21 Bay State Rd
Boston, MA 02215-2101
Phone
(617) 247-9966
NPI assigned
Dec 29, 2012
Last updated
Jan 3, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2013

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

Authorized official

Name
Dr. Richard Miller, DMDNPI 1356463665
Title
President
Phone
(617) 921-6292

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
Dentist 122300000X NU Primary

Addresses

Primary practice location

21 Bay State Rd
Boston, MA 02215-2101

Mailing address

21 Bay State Rd
Boston, MA 02215-2101

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1356739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357171200000",
    "number": "1063758639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 BAY STATE RD",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022152101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 BAY STATE RD",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022152101",
            "telephone_number": "617-247-9966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK BAY DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-29",
        "last_updated": "2013-01-03",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-921-6292",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2013; 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.