Active NPI
Justin Maillet, DMD
- Dentist
- Nashua, NH
National Provider Identifier
1154843464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 04328
- Practice address
- 45 High St
Nashua, NH 03060-3312 - Phone
- (603) 821-6122
- Fax
- (603) 821-5620
- NPI assigned
- Jul 10, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 | 04328 | NH | Primary |
Addresses
Primary practice location
45 High St
Nashua, NH 03060-3312
Mailing address
77 Northeastern Blvd Ste C
Nashua, NH 03062-3128
Phone (603) 882-3616
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170825000560 | NH | Order and Referring Only - Dentist | 6204108251 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04328 | NH | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1505174400000",
"number": "1154843464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "77 NORTHEASTERN BLVD STE C",
"city": "NASHUA",
"state": "NH",
"postal_code": "030623128",
"telephone_number": "603-882-3616",
"fax_number": "603-595-7414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45 HIGH ST",
"city": "NASHUA",
"state": "NH",
"postal_code": "030603312",
"telephone_number": "603-821-6122",
"fax_number": "603-821-5620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAILLET",
"first_name": "JUSTIN",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-07-10",
"last_updated": "2017-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NH",
"license": "04328",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nashua, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.