NPIMap

Organization Active NPI

Mystic Dental Studio PC

  • Dentist
  • Chelsea, MA
National Provider Identifier
1083046114
Registry record updated Jul 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
20625 Issued in MA
Legal business name
MYSTIC DENTAL STUDIO PC
Practice address
158 Everett Ave
Unit 5
Chelsea, MA 02150-1813
Phone
(617) 884-6800
NPI assigned
Jul 31, 2013
Last updated
Jul 31, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2013

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

Authorized official

Name
Aida Padron, DMD
Title
Owner
Phone
(617) 884-6800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 20625 MA Primary

Addresses

Primary practice location

158 Everett Ave
Unit 5
Chelsea, MA 02150-1813

Mailing address

158 Everett Ave
Unit 5
Chelsea, MA 02150-1813
Phone (617) 884-6800

National Provider Directory

National Provider Directory

Locations

158 Everett Ave
Unit 5
Chelsea, MA 02150
Phone (617) 820-9591

Practitioners & affiliated clinicians

Practitioners 1

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": "1375228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375228800000",
    "number": "1083046114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 EVERETT AVE",
            "address_2": "UNIT 5",
            "city": "CHELSEA",
            "state": "MA",
            "postal_code": "021501813",
            "telephone_number": "617-884-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 EVERETT AVE",
            "address_2": "UNIT 5",
            "city": "CHELSEA",
            "state": "MA",
            "postal_code": "021501813",
            "telephone_number": "617-884-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC DENTAL STUDIO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-31",
        "last_updated": "2013-07-31",
        "status": "A",
        "authorized_official_last_name": "PADRON",
        "authorized_official_first_name": "AIDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-884-6800",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "20625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chelsea, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 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.