NPIMap

Organization Active NPI

Cronins Dental PC

  • Dentist
  • Waltham, MA
National Provider Identifier
1104955723
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
CRONINS DENTAL PC
Practice address
225 Moody St
Waltham, MA 02453
Phone
(781) 647-8000
Fax
(781) 647-8111
NPI assigned
Mar 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Taejoon Ahn, DMDNPI 1104042118
Title
Owner
Phone
(781) 647-8000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

225 Moody St
Waltham, MA 02453

Mailing address

225 Moody St
Waltham, MA 02453
Phone (781) 647-8000

Other identifiers 1

IdentifierTypeStateIssuer
X11231OtherBCBS

National Provider Directory

National Provider Directory

Locations

225 Moody St
Waltham, MA 02453
Phone (781) 647-8000

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104955723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 MOODY ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "02453",
            "telephone_number": "781-647-8000",
            "fax_number": "781-647-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 MOODY ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "02453",
            "telephone_number": "781-647-8000",
            "fax_number": "781-647-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRONINS DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AHN",
        "authorized_official_first_name": "TAEJOON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-647-8000",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "X11231",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waltham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.