NPIMap

Organization Active NPI

Four Corners Dental Care

  • Dentist
  • Woburn, MA
National Provider Identifier
1154774404
Registry record updated Jul 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
15162 Issued in MA
Legal business name
FOUR CORNERS DENTAL CARE
Practice address
237 Lexington St
Suite 210
Woburn, MA 01801-5984
Phone
(781) 933-4144
Fax
(781) 933-4649
NPI assigned
Jul 21, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2016

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

Authorized official

Name
Kristin Marie Moutevelis
Title
Business Manager
Phone
(781) 933-4144

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 15162 MA Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 21707 MA

Addresses

Primary practice location

237 Lexington St
Suite 210
Woburn, MA 01801-5984

Mailing address

237 Lexington St
Suite 210
Woburn, MA 01801-5984
Phone (781) 933-4144

Other names 1

  • George P. Moutevelis, DMD Other name

National Provider Directory

National Provider Directory

Locations

237 Lexington St
Ste 210
Woburn, MA 01801
Phone (781) 933-4144

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1469059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469059200000",
    "number": "1154774404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "237 LEXINGTON ST",
            "address_2": "SUITE 210",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018015984",
            "telephone_number": "781-933-4144",
            "fax_number": "781-933-4649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "237 LEXINGTON ST",
            "address_2": "SUITE 210",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018015984",
            "telephone_number": "781-933-4144",
            "fax_number": "781-933-4649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR CORNERS DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-21",
        "last_updated": "2016-07-21",
        "status": "A",
        "authorized_official_last_name": "MOUTEVELIS",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "781-933-4144"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "15162",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "21707",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "George P. Moutevelis, DMD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Woburn, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.

Verify at the official NPI Registry.