Active NPI
Margaret Emma Quintanilla, D.D.S.
- Endodontics
- Brockton, MA
National Provider Identifier
1205210416
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- DL12578
- Practice address
- 63 Main St
Brockton, MA 02301 - Phone
- (508) 559-6699
- NPI assigned
- Jul 17, 2015
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | DL12578 | MA | Primary |
Addresses
Primary practice location
63 Main St
Brockton, MA 02301
Mailing address
63 Main St
Brockton, MA 02301-4042
Phone (508) 559-6699
Other practice location 1
1049 Main Street
Springfield, MA 01103
Phone (413) 304-4606
Other practice location 2
1049 Main Street
Springfield, MA 01103
Phone (413) 304-4606
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110028120 | Medicaid | MA |
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 |
|---|---|---|---|---|
| I20160106001301 | MA | Order and Referring Only - Dentist | 9830491901 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557878400000",
"number": "1205210416",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "63 MAIN ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023014042",
"telephone_number": "508-559-6699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "63 MAIN ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "02301",
"telephone_number": "508-559-6699"
}
],
"practiceLocations": [
{
"address_1": "1049 Main Street",
"address_purpose": "LOCATION",
"city": "Springfield",
"state": "MA",
"postal_code": "01103",
"country_code": "US",
"telephone_number": "413-304-4606",
"fax_number": "413-737-3608",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1049 Main Street",
"address_purpose": "LOCATION",
"city": "Springfield",
"state": "MA",
"postal_code": "01103",
"country_code": "US",
"telephone_number": "413-304-4606",
"fax_number": "413-737-3608",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "QUINTANILLA",
"first_name": "MARGARET",
"middle_name": "EMMA",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-07-17",
"last_updated": "2019-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "MA",
"license": "DL12578",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110028120",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2019; 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.