West Roxbury Modern Dentistry, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

WEST ROXBURY MODERN DENTISTRY, PC

Doing business as

West Roxbury Modern Dentistry

Practice address

75 Spring St Ste 100a
West Roxbury, MA 02132-4335

Phone

(857) 353-5103

Fax

(957) 264-2506

NPI assigned

Jun 23, 2023

Organization subpart

No

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

Authorized official

Name

Frederick Lee, DMD

Title

Owner

Phone

(857) 353-5103

Specialties & licenses 1

Addresses

Other names 1

• West Roxbury Modern Dentistry Doing business as

Locations

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

{
    "created_epoch": "1687478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687478400000",
    "number": "1073299137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 SPRING ST STE 100A",
            "city": "WEST ROXBURY",
            "state": "MA",
            "postal_code": "021324335",
            "telephone_number": "857-353-5103",
            "fax_number": "957-264-2506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST ROXBURY MODERN DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-23",
        "last_updated": "2023-06-23",
        "certification_date": "2023-06-23",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "857-353-5103",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Roxbury Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gabriella Antionette Watson, OD
• Ebony Weathers
• Kyle Weaver
• Wellspring Mentors LLC
• West Roxbury Dental Arts
• Jennifer Lauren Weston, CCC-SLP
• Noah M Whiddon, LMSW
• Jacqueline White
• Julie C White, NP
• Sarah Kelley White, ACNP-BC

• General Practice Dentistry in West Roxbury, MA
• Providers in West Roxbury, 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 Jun 23, 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.