NPIMap

Organization Active NPI

Omni Dentix & Assoc.

  • Pediatric Dentistry
  • Medford, MA
National Provider Identifier
1104088491
Registry record updated Jun 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
15376 Issued in MA
Legal business name
OMNI DENTIX & ASSOC.
Practice address
3850 Mystic Valley Pkwy
Suite 20
Medford, MA 02155-6901
Phone
(781) 396-6613
Fax
(781) 395-4292
NPI assigned
Jun 27, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2008

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

Authorized official

Name
Mr. Mohammed E Mobasherat, D.M.D, D.D.S.,
Title
President
Phone
(781) 396-6613

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 20309 MA
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 15376 MA Primary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X 13913 MA

Addresses

Primary practice location

3850 Mystic Valley Pkwy
Suite 20
Medford, MA 02155-6901

Mailing address

3850 Mystic Valley Pkwy
Suite 20
Medford, MA 02155-6901
Phone (781) 396-6613

Other identifiers 3

IdentifierTypeStateIssuer
0263702MedicaidMA
0205401MedicaidMA
0268361MedicaidMA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1214524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1104088491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3850 MYSTIC VALLEY PKWY",
            "address_2": "SUITE 20",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021556901",
            "telephone_number": "781-396-6613",
            "fax_number": "781-395-4292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 MYSTIC VALLEY PKWY",
            "address_2": "SUITE 20",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021556901",
            "telephone_number": "781-396-6613",
            "fax_number": "781-395-4292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI DENTIX & ASSOC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-27",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "MOBASHERAT",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-396-6613",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.M.D, D.D.S.,"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "20309",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MA",
            "license": "15376",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MA",
            "license": "13913",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0263702",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0205401",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0268361",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; 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.