Distinctive Dental Associates

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

DISTINCTIVE DENTAL ASSOCIATES

Practice address

255 Park Ave
Suite 904
Worcester, MA 01609-1953

Phone

(508) 792-9010

Fax

(508) 754-7856

NPI assigned

May 22, 2007

Last updated

Jun 18, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Stephen Waxman, D.M.D.NPI 1528271319

Title

Dentist

Phone

(508) 792-9010

Specialties & licenses 1

Addresses

Other names 1

• Dr.'s Waxman and Giordano Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stephen Waxman, D.M.D.

  • Dentist
  • Worcester, MA
  • NPI 1528271319
  Authorized official Same address or phone

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1114136504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 PARK AVE",
            "address_2": "SUITE 904",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016091953",
            "telephone_number": "508-792-9010",
            "fax_number": "508-754-7856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 PARK AVE",
            "address_2": "SUITE 904",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016091953",
            "telephone_number": "508-792-9010",
            "fax_number": "508-754-7856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISTINCTIVE DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "WAXMAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "508-792-9010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr.'s Waxman and Giordano",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Lisa M Dirienzo, MS, RD, LDN
• Heidi Lynn Diroberto, LMHC
• Steven Thomas Disegna, MD
• Kevin James Disilvestro, MD
• Mark S Distefano, M.D.
• Stephanie Ditommaso, CNP
• Nathan Dittmer, L.I.C.S.W.
• Gretchen Dittrich
• Brandon Robert Ditullio, MS., BCBA, LABA.
• Christopher Michael Ditullio, MD

• Dentist in Worcester, MA
• Providers in Worcester, MA by specialty
• Dentist in Massachusetts

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