Active NPI
Kelly Ann Scanlon-Chase, D.M.D.
- General Practice Dentistry
- Wilbraham, MA
National Provider Identifier
1073737748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 17956
- Practice address
- 2377 Boston Rd
Suite 103
Wilbraham, MA 01095-1254 - Phone
- (413) 596-6444
- Fax
- (413) 596-6237
- NPI assigned
- Apr 12, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 17956 | MA | Primary |
Addresses
Primary practice location
2377 Boston Rd
Suite 103
Wilbraham, MA 01095-1254
Mailing address
2377 Boston Rd
Suite 103
Wilbraham, MA 01095-1254
Phone (413) 596-6444
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053350470 | Other | MA | NPI-BOULDER BROOK DENTAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17956 | MA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073737748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2377 BOSTON RD",
"address_2": "SUITE 103",
"city": "WILBRAHAM",
"state": "MA",
"postal_code": "010951254",
"telephone_number": "413-596-6444",
"fax_number": "413-596-6237"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2377 BOSTON RD",
"address_2": "SUITE 103",
"city": "WILBRAHAM",
"state": "MA",
"postal_code": "010951254",
"telephone_number": "413-596-6444",
"fax_number": "413-596-6237"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCANLON-CHASE",
"first_name": "KELLY",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "17956",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI-BOULDER BROOK DENTAL",
"identifier": "1053350470",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilbraham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.