Center for Dental Medicine & Reconstruction

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

Legal business name

CENTER FOR DENTAL MEDICINE & RECONSTRUCTION

Practice address

152 Lincoln Rd Ste 1
Lincoln, MA 01773-3832

Phone

(781) 728-5455

NPI assigned

Apr 23, 2019

Last updated

Apr 23, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Quinn Chan, DMDNPI 1669663886

Title

Owner/Manager

Phone

(781) 728-5455

Specialties & licenses 4

Addresses

Other identifiers 2

Practitioners 2

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.

• Quinn Kin-Wung Chan, D.M.D.

  • Prosthodontics
  • Lincoln, MA
  • NPI 1669663886
  NPD (past) Authorized official
• Bina Oh, DMD

  • Periodontics
  • Lincoln, MA
  • NPI 1821365479
  NPD (past)

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

{
    "created_epoch": "1555977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555977600000",
    "number": "1083278378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 TRAVELER ST UNIT 510",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182840",
            "telephone_number": "617-851-5463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 LINCOLN RD STE 1",
            "city": "LINCOLN",
            "state": "MA",
            "postal_code": "017733832",
            "telephone_number": "781-728-5455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR DENTAL MEDICINE & RECONSTRUCTION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-23",
        "last_updated": "2019-04-23",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "QUINN",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "781-728-5455",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669663886",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821365479",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daphne Blount, L.I.C.S.W.
• Judith Boyle, LICSW
• BSL- BN Commons SNF Operator LLC
• BSL- BN Commons SNF Operator LLC (Benchmark Senior Living at The Commons in Lincoln, Skilled Nursing Fac)
• Jacqueline Butler, LICSW
• Quinn Kin-Wung Chan, D.M.D.
• Kathryn Colleran Oommen
• Anthony Joseph Cornette, AS
• Nicholas Arthur Covino, PSYD
• Craig Sussman

• Prosthodontics in Lincoln, MA
• Providers in Lincoln, MA by specialty
• Prosthodontics in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; 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.