Active NPI
Matthew R Annese, D.M.D
- Dentist
- Boston, MA
National Provider Identifier
1114289246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN1856006
- Practice address
- 637 Washington St
Dental Department
Boston, MA 02124-3510 - Phone
- (617) 822-4747
- NPI assigned
- Jun 14, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN1856006 | MA | Primary |
Addresses
Primary practice location
637 Washington St
Dental Department
Boston, MA 02124-3510
Mailing address
111 Willow Ave
Apt 1
Somerville, MA 02144-2527
Phone (978) 804-3641
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1856006 | MA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407801600000",
"number": "1114289246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 WILLOW AVE",
"address_2": "APT 1",
"city": "SOMERVILLE",
"state": "MA",
"postal_code": "021442527",
"telephone_number": "978-804-3641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "637 WASHINGTON ST",
"address_2": "DENTAL DEPARTMENT",
"city": "BOSTON",
"state": "MA",
"postal_code": "021243510",
"telephone_number": "617-822-4747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANNESE",
"first_name": "MATTHEW",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-14",
"last_updated": "2014-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DN1856006",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.