NPIMap

Organization Active NPI

Mendon Family Dentistry

  • Dentist
  • Mendon, MA
National Provider Identifier
1083168132
Registry record updated Sep 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
20209 Issued in MA
Legal business name
MENDON FAMILY DENTISTRY
Practice address
14 Hastings St
Mendon, MA 01756-1079
Phone
(508) 478-8683
NPI assigned
Aug 6, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2016

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

Authorized official

Name
Joanne Tavano
Title
Coo
Phone
(978) 580-1524

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 20209 MA Primary
Point of Service 305S00000X 20209 MA

Addresses

Primary practice location

14 Hastings St
Mendon, MA 01756-1079

Mailing address

5 Mount Royal Ave Ste 300
Marlborough, MA 01752-1900
Phone (508) 460-0632

National Provider Directory

National Provider Directory
Tax ID family
Mendon Family Dentistry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

14 Hastings St
Mendon, MA 01756
Phone (508) 478-8683

NPI Registry JSON

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

{
    "created_epoch": "1470441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473811200000",
    "number": "1083168132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 MOUNT ROYAL AVE STE 300",
            "city": "MARLBOROUGH",
            "state": "MA",
            "postal_code": "017521900",
            "telephone_number": "508-460-0632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 HASTINGS ST",
            "city": "MENDON",
            "state": "MA",
            "postal_code": "017561079",
            "telephone_number": "508-478-8683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDON FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-06",
        "last_updated": "2016-09-14",
        "status": "A",
        "authorized_official_last_name": "TAVANO",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "978-580-1524"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "20209",
            "primary": true
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "MA",
            "license": "20209",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mendon, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; 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.