Individual provider Active NPI

Debra J. Blattman, DMD

  • General Practice Dentistry
  • Needham, MA
National Provider Identifier
1073604104
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
21416 Issued in MA
Practice address
87 Chestnut St
Needham, MA 02492-2578
Phone
(781) 444-6650
Fax
(781) 444-3607
NPI assigned
Sep 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 21416 MA Primary

Addresses

Primary practice location

87 Chestnut St
Needham, MA 02492-2578

Mailing address

900 Lexington St
B-1
Waltham, MA 02452-4852
Phone (781) 373-5706

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150624001322 MA Order and Referring Only - DentistPractitioner - Dentist 6103137625

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
21416MAMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073604104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 LEXINGTON ST",
            "address_2": "B-1",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024524852",
            "telephone_number": "781-373-5706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "87 CHESTNUT ST",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "024922578",
            "telephone_number": "781-444-6650",
            "fax_number": "781-444-3607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLATTMAN",
        "first_name": "DEBRA",
        "middle_name": "J.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "21416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Needham, MA

Sources for this page

Verify at the official NPI Registry.