Active NPI
Olga Krasnoslobodtseva
- General Practice Dentistry
- Milton, MA
National Provider Identifier
1205236122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN1856680
- Practice address
- 398 Blue Hills Pkwy
Milton, MA 02186-2738 - Phone
- (617) 615-8371
- NPI assigned
- Aug 27, 2014
- Sex
- Female
- 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 | DN1856680 | MA | Primary |
Addresses
Primary practice location
398 Blue Hills Pkwy
Milton, MA 02186-2738
Mailing address
398 Blue Hills Pkwy
Milton, MA 02186-2738
Phone (617) 615-8371
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 |
|---|---|---|---|---|
| I20220104002659 | MA | Order and Referring Only - Dentist | 7810388626 |
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": "1409097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409097600000",
"number": "1205236122",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "398 BLUE HILLS PKWY",
"city": "MILTON",
"state": "MA",
"postal_code": "021862738",
"telephone_number": "617-615-8371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "398 BLUE HILLS PKWY",
"city": "MILTON",
"state": "MA",
"postal_code": "021862738",
"telephone_number": "617-615-8371"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRASNOSLOBODTSEVA",
"first_name": "OLGA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-08-27",
"last_updated": "2014-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "DN1856680",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2014; 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.