NPIMap

Organization Active NPI

Community Family Dental

  • General Practice Dentistry
  • Roslindale, MA
National Provider Identifier
1205061207
Registry record updated May 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
18643 Issued in MA
Legal business name
COMMUNITY FAMILY DENTAL
Practice address
648 American Legion Hwy
Roslindale, MA 02131-3901
Phone
(617) 699-9894
NPI assigned
May 19, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2009

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

Authorized official

Name
Andrey Mazo, DMD
Title
Owner
Phone
(617) 285-6414

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 18643 MA Primary

Addresses

Primary practice location

648 American Legion Hwy
Roslindale, MA 02131-3901

Mailing address

648 American Legion Hwy
Roslindale, MA 02131-3901
Phone (617) 699-9894

Other identifiers 1

IdentifierTypeStateIssuer
0277975MedicaidMA

National Provider Directory

National Provider Directory
Tax ID family
Community Family Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

648 American Legion Hwy
Roslindale, MA 02131
Phone (617) 699-9894

NPI Registry JSON

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

{
    "created_epoch": "1242691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242691200000",
    "number": "1205061207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "648 AMERICAN LEGION HWY",
            "city": "ROSLINDALE",
            "state": "MA",
            "postal_code": "021313901",
            "telephone_number": "617-699-9894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "648 AMERICAN LEGION HWY",
            "city": "ROSLINDALE",
            "state": "MA",
            "postal_code": "021313901",
            "telephone_number": "617-699-9894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-19",
        "last_updated": "2009-05-19",
        "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_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "18643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0277975",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roslindale, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2009; 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.