Individual provider Active NPI

Debbie Susan Eisen, D.M.D.

  • General Practice Dentistry
  • Swampscott, MA
National Provider Identifier
1215947692
Registry record updated Sep 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
17367 Issued in MA
Practice address
440 Humphrey St
Swampscott, MA 01907-2574
Phone
(781) 598-0040
NPI assigned
Aug 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 17367 MA Primary

Addresses

Primary practice location

440 Humphrey St
Swampscott, MA 01907-2574

Mailing address

39 Home St
Malden, MA 02148-3248
Phone (781) 322-5952

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160622002340 MA Order and Referring Only - DentistPractitioner - Dentist 8123319142

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
17367MAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378771200000",
    "number": "1215947692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 HOME ST",
            "city": "MALDEN",
            "state": "MA",
            "postal_code": "021483248",
            "telephone_number": "781-322-5952",
            "fax_number": "781-324-6990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 HUMPHREY ST",
            "city": "SWAMPSCOTT",
            "state": "MA",
            "postal_code": "019072574",
            "telephone_number": "781-598-0040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EISEN",
        "first_name": "DEBBIE",
        "middle_name": "SUSAN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-09",
        "last_updated": "2013-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "17367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Swampscott, MA

Sources for this page

Verify at the official NPI Registry.