Active NPI
Richard Loguercio, D.D.S.
- General Practice Dentistry
- Randolph, MA
National Provider Identifier
1164405759
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12372
- Practice address
- 56 S Main St
Randolph, MA 02368-4821 - Phone
- (781) 963-0860
- Fax
- (781) 961-2445
- NPI assigned
- Nov 28, 2005
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12372 | MA | Primary |
Addresses
Primary practice location
56 S Main St
Randolph, MA 02368-4821
Mailing address
56 S Main St
Randolph, MA 02368-4821
Phone (781) 963-0860
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- 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 |
|---|---|---|---|---|
| I20150407000932 | MA | Order and Referring Only - Dentist | 9931427721 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12372 | MA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164405759",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "56 S MAIN ST",
"city": "RANDOLPH",
"state": "MA",
"postal_code": "023684821",
"telephone_number": "781-963-0860",
"fax_number": "781-961-2445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "56 S MAIN ST",
"city": "RANDOLPH",
"state": "MA",
"postal_code": "023684821",
"telephone_number": "781-963-0860",
"fax_number": "781-961-2445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOGUERCIO",
"first_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "12372",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Randolph, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.