Nicholas James Boutselis, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

18573 Issued in MA

Practice address

381R Main Street
Tewksbury, MA 01876

Phone

(978) 640-1114

Fax

(978) 640-1117

NPI assigned

Aug 7, 2008

Sex

Male

Sole proprietor

No

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

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Boutselis Family Dental Care PC

  • General Practice Dentistry
  • Tewksbury, MA
  • NPI 1457423154
  NPD (past)

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

{
    "created_epoch": "1218067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218067200000",
    "number": "1093961245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "381R MAIN STREET",
            "city": "TEWKSBURY",
            "state": "MA",
            "postal_code": "01876",
            "telephone_number": "978-640-1114",
            "fax_number": "978-640-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "381R MAIN STREET",
            "city": "TEWKSBURY",
            "state": "MA",
            "postal_code": "01876",
            "telephone_number": "978-640-1114",
            "fax_number": "978-640-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTSELIS",
        "first_name": "NICHOLAS",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-07",
        "last_updated": "2008-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "18573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monika Bonfiglio
• Elizabeth Bossi
• Boston Behavioral Health Consulting, PLLC
• Laurie B. Botie, MD
• Boutselis Family Dental Care PC
• Michael Bove, PT
• Nora Frances Bowen, LICSW
• Ruby Leah Boyd, MD
• Kathleen Brady, M.D.
• Lauren Bregoli, PA-S

• General Practice Dentistry in Tewksbury, MA
• Providers in Tewksbury, 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 Aug 7, 2008; 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.