Fresh Pond Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

18643 Issued in MA

Legal business name

FRESH POND DENTAL LLC

Practice address

180 Alewife Brook Pkwy
Cambridge, MA 02138-1102

Phone

(617) 547-0700

NPI assigned

Nov 22, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Andrey Mazo

Title

Owner

Phone

(617) 285-6414

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1321920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321920000000",
    "number": "1134496904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 ALEWIFE BROOK PKWY",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021381102",
            "telephone_number": "617-547-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 ALEWIFE BROOK PKWY",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021381102",
            "telephone_number": "617-547-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESH POND DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-22",
        "last_updated": "2011-11-22",
        "status": "A",
        "authorized_official_last_name": "MAZO",
        "authorized_official_first_name": "ANDREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-285-6414",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MA",
            "license": "18643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Freedom Health Infusion, LLC
• Laura Freeman
• Madeline Freeman
• Jesse French
• Kimberly Ann French, RPH,CIP
• Fresh Pond Neuropsychology PLLC
• Holly Friedman Housman, L.I.C.S.W.
• Cary Drew Friedman, M.D.
• Henry J. Friedman, M.D.
• Jeffrey Robert Friedman, M.D.

• Dental Clinic/Center in Cambridge, MA
• Providers in Cambridge, MA by specialty
• Dental Clinic/Center in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2011; 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.