Tina Renee Theroux

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

20219 Issued in MA

Practice address

103 Worcester St Ste a
North Grafton, MA 01536-1050

Phone

(508) 839-2262

Fax

(508) 839-6556

NPI assigned

Oct 19, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666742400000",
    "number": "1083796023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 WORCESTER ST STE A",
            "city": "NORTH GRAFTON",
            "state": "MA",
            "postal_code": "015361050",
            "telephone_number": "508-839-2262",
            "fax_number": "508-839-6556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 WORCESTER ST STE A",
            "city": "NORTH GRAFTON",
            "state": "MA",
            "postal_code": "015361050",
            "telephone_number": "508-839-2262",
            "fax_number": "508-839-6556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEROUX",
        "first_name": "TINA",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-19",
        "last_updated": "2022-10-26",
        "certification_date": "2022-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "20219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah St. Germain, LABA
• Stat-Care Pharmacy, LLC
• Roberta Taylor
• Theroux Dental Associates
• Taylor Theroux
• Kathleen Anne Thomas
• Bella Thornton
• Through the Clouds Counseling, LLC
• Hailey Vaitkunas
• David Vensel, DPT

• General Practice Dentistry in North Grafton, MA
• Providers in North Grafton, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.