Active NPI
Maureen Moore
- Dental Hygienist
- Mattapan, MA
National Provider Identifier
1124438379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- DH4628
- Practice address
- 1135 Morton St
Mattapan, MA 02126-2834 - Phone
- (617) 533-2300
- Fax
- (617) 533-2341
- NPI assigned
- Apr 28, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | DH4628 | MA | Primary |
| Dental Hygienist | 124Q00000X |
Addresses
Primary practice location
1135 Morton St
Mattapan, MA 02126-2834
Mailing address
250 Mount Vernon St
Dorchester, MA 02125-3120
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 |
|---|---|---|---|
| DH4628 | MA | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398643200000",
"number": "1124438379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 MOUNT VERNON ST",
"city": "DORCHESTER",
"state": "MA",
"postal_code": "021253120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1135 MORTON ST",
"city": "MATTAPAN",
"state": "MA",
"postal_code": "021262834",
"telephone_number": "617-533-2300",
"fax_number": "617-533-2341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "MAUREEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-28",
"last_updated": "2014-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "MA",
"license": "DH4628",
"primary": true
},
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mattapan, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.