NPIMap

Organization Active NPI

Modern Dental Associates, LLC

  • Dental Clinic/Center
  • Brookline, MA
National Provider Identifier
1083317374
Registry record updated Mar 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
MODERN DENTAL ASSOCIATES, LLC
Practice address
1037 Beacon Street Apt 2
Brookline, MA 02446
Phone
(617) 738-7210
NPI assigned
Mar 24, 2023
Last updated
Mar 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2023

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

Authorized official

Name
Dr. Heather Coubrough, DMD, FAGDNPI 1245541200
Title
Owner/Dentist
Phone
(617) 256-7739

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

1037 Beacon Street Apt 2
Brookline, MA 02446

Mailing address

1037 Beacon Street
Suite 2
Brookline, MA 02446
Phone (617) 738-7210

Other practice location 1

1037 Beacon St Apt 2
Brookline, MA 02446
Phone (617) 738-7210

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1679616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679875200000",
    "number": "1083317374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1037 BEACON STREET",
            "address_2": "SUITE 2",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "02446",
            "telephone_number": "617-738-7210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1037 BEACON STREET APT 2",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "02446",
            "telephone_number": "617-738-7210"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1037 Beacon St Apt 2",
            "address_purpose": "LOCATION",
            "city": "Brookline",
            "state": "MA",
            "postal_code": "02446",
            "country_code": "US",
            "telephone_number": "617-738-7210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MODERN DENTAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-24",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A",
        "authorized_official_last_name": "COUBROUGH",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "617-256-7739",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, FAGD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookline, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; 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.