Active NPI
Mira Khouzam, DMD
- Dentist
- Lexington, MA
National Provider Identifier
1215482153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN1857394
- Practice address
- 394 Lowell St Ste 2
Lexington, MA 02420-2575 - Phone
- (781) 656-5321
- NPI assigned
- Aug 21, 2016
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DN1857394 | MA | Primary |
Addresses
Primary practice location
394 Lowell St Ste 2
Lexington, MA 02420-2575
Mailing address
2350 Commonwealth Ave Apt 1-2
Auburndale, MA 02466-1727
Phone (857) 265-9644
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 12, 2022 through Jul 12, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1857394 | MA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Associates II | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Orthodontics and Dentofacial Orthopedics Dentistry
- Attleboro Falls, MA
- NPI 1053433680
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471737600000",
"number": "1215482153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2350 COMMONWEALTH AVE APT 1-2",
"city": "AUBURNDALE",
"state": "MA",
"postal_code": "024661727",
"telephone_number": "857-265-9644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "394 LOWELL ST STE 2",
"city": "LEXINGTON",
"state": "MA",
"postal_code": "024202575",
"telephone_number": "781-656-5321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHOUZAM",
"first_name": "MIRA",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-21",
"last_updated": "2016-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DN1857394",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lexington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.