Individual provider Active NPI

Russell K. Hagopian, DMD

  • General Practice Dentistry
  • Lexington, MA
National Provider Identifier
1104859024
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
14786 Issued in MA
Practice address
922 Waltham St
Suite 210
Lexington, MA 02421-8019
Phone
(781) 862-8662
Fax
(781) 862-6187
NPI assigned
Jul 7, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 14786 MA Primary

Addresses

Primary practice location

922 Waltham St
Suite 210
Lexington, MA 02421-8019

Mailing address

922 Waltham St
Suite 210
Lexington, MA 02421-8019
Phone (781) 862-8662

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160321001406 MA Order and Referring Only - DentistPractitioner - Dentist 5496052318

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14786MAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Coletti Dental LLC General Practice PastSince Dec 6, 2022 Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104859024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "922 WALTHAM ST",
            "address_2": "SUITE 210",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024218019",
            "telephone_number": "781-862-8662",
            "fax_number": "781-862-6187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "922 WALTHAM ST",
            "address_2": "SUITE 210",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024218019",
            "telephone_number": "781-862-8662",
            "fax_number": "781-862-6187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGOPIAN",
        "first_name": "RUSSELL",
        "middle_name": "K.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "14786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, MA

Sources for this page

Verify at the official NPI Registry.