Active NPI
Mathi Theva
- Dentist
- Brockton, MA
National Provider Identifier
1114956315
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 17809
- Practice address
- 200 West Gate Dr
Suite 135 Unident Dental Center
Brockton, MA 02301 - Phone
- (508) 583-3840
- Fax
- (508) 559-6577
- NPI assigned
- Jul 1, 2006
- Sex
- Female
- Sole proprietor
- No
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 | 17809 | MA | Primary |
Addresses
Primary practice location
200 West Gate Dr
Suite 135 Unident Dental Center
Brockton, MA 02301
Mailing address
99 Canavan Drive
Braintree, MA 02184
Phone (781) 849-3422
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0273449 | Medicaid | MA |
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 |
|---|---|---|---|
| 17809 | MA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mathi Theva DMD PC | Dentist | Past | 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 and National Provider Directory roles.
-
- Dentist
- Brockton, MA
- NPI 1699704999
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114956315",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "99 CANAVAN DRIVE",
"city": "BRAINTREE",
"state": "MA",
"postal_code": "02184",
"telephone_number": "781-849-3422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 WEST GATE DR",
"address_2": "SUITE 135 UNIDENT DENTAL CENTER",
"city": "BROCKTON",
"state": "MA",
"postal_code": "02301",
"telephone_number": "508-583-3840",
"fax_number": "508-559-6577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEVA",
"first_name": "MATHI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "17809",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0273449",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.