Dr. Dental of Methuen, PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

20485 Issued in MA

Legal business name

DR. DENTAL OF METHUEN, PC

Practice address

162 Haverhill St
Methuen, MA 01844-3462

Phone

(617) 887-2100

Fax

(617) 887-2102

NPI assigned

May 18, 2011

Organization subpart

No

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

Authorized official

Name

Chris Incollingo

Title

Manager

Phone

(617) 887-2100

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1305676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305676800000",
    "number": "1083907406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "162 HAVERHILL ST",
            "city": "METHUEN",
            "state": "MA",
            "postal_code": "018443462",
            "telephone_number": "617-887-2100",
            "fax_number": "617-887-2102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "162 HAVERHILL ST",
            "city": "METHUEN",
            "state": "MA",
            "postal_code": "018443462",
            "telephone_number": "617-887-2100",
            "fax_number": "617-887-2102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. DENTAL OF METHUEN, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-18",
        "last_updated": "2011-05-18",
        "status": "A",
        "authorized_official_last_name": "INCOLLINGO",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "617-887-2100"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MA",
            "license": "20485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9794395",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ania Donat Mortel
• Megan Dorismond
• Dormer Speech and Listening LLC
• Michael J Dormer, MS, SLP-CCC
• James Doyle, O.D.
• Alyssa Drouin
• Joann Marie Duffy, RN
• Diana Dungan, RN-BC
• Jamie Dunphy
• Anh N Duong, NP

• Dental Clinic/Center in Methuen, MA
• Providers in Methuen, MA by specialty
• Dental Clinic/Center in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2011; 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.