Active NPI
Esra M. Faden
- Periodontics
- Boston, MA
National Provider Identifier
1124573456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 13-J-D-0030293
- Practice address
- 1 Kneeland St
Boston, MA 02111-1527 - Phone
- (617) 817-0656
- NPI assigned
- Aug 16, 2016
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 13-J-D-0030293 | ZZ | Primary |
Addresses
Primary practice location
1 Kneeland St
Boston, MA 02111-1527
Mailing address
75 Station LNDG
Apt. 526, Medford, Ma
Medford, MA 02155-5127
Phone (617) 817-0656
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 |
|---|---|---|---|
| 13-J-D-0030293 | ZZ | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471305600000",
"number": "1124573456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 STATION LNDG",
"address_2": "APT. 526, MEDFORD, MA",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021555127",
"telephone_number": "617-817-0656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 KNEELAND ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021111527",
"telephone_number": "617-817-0656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FADEN",
"first_name": "ESRA",
"middle_name": "M.",
"name_prefix": "Miss",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-16",
"last_updated": "2016-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "ZZ",
"license": "13-J-D-0030293",
"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 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.