Baystate Dental PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

15623 Issued in MA

Legal business name

BAYSTATE DENTAL PC

Practice address

1795 Main St
Springfield, MA 01103-1077

Phone

(413) 733-6651

NPI assigned

May 17, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Ann Marie Santos

Title

Office Manager

Phone

(413) 733-6651

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

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

• Kevin Coughlin, DMD

  • General Practice Dentistry
  • Springfield, MA
  • NPI 1801846324
  NPD (past)
• Matthew John Haluch, DDS

  • General Practice Dentistry
  • Springfield, MA
  • NPI 1588619332
  NPD (past)

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194932368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1795 MAIN ST",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011031077",
            "telephone_number": "413-733-6651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1795 MAIN ST",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011031077",
            "telephone_number": "413-733-6651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYSTATE DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SANTOS",
        "authorized_official_first_name": "ANN MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "413-733-6651",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "15623",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9730460",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Timothy Baymon, NP
• Muhammed Cagri Bayraktutan, MD
• Bayside Pediatrics PC
• Baystate Academy Charter Public School
• Baystate Affiliated Practice Organization
• Baystate Dental Practice, LLC
• Baystate Developmental Behavioral Pediatrics
• Baystate Eye Care Optical Shoppe
• Baystate Eye Group
• Baystate Medical Center Inc

• General Practice Dentistry in Springfield, MA
• Providers in Springfield, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.