Active NPI
Robert J Moreau Sr., D.M.D.
- Pediatric Dentistry
- Mansfield, MA
National Provider Identifier
1225160138
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 18512
- Practice address
- 905 S Main St
Suite 102
Mansfield, MA 02048-3149 - Phone
- (508) 337-3307
- Fax
- (508) 337-3317
- NPI assigned
- Mar 9, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 18512 | MA | Primary |
Addresses
Primary practice location
905 S Main St
Suite 102
Mansfield, MA 02048-3149
Mailing address
905 S Main St
Suite 102
Mansfield, MA 02048-3149
Phone (508) 337-3307
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| X12178 | Other | MA | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Dec 15, 2015 through Dec 15, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18512 | MA | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Dental Center of Mansfield | 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.
-
- Dental Clinic/Center
- Mansfield, MA
- NPI 1982876942
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452038400000",
"number": "1225160138",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "905 S MAIN ST",
"address_2": "SUITE 102",
"city": "MANSFIELD",
"state": "MA",
"postal_code": "020483149",
"telephone_number": "508-337-3307",
"fax_number": "508-337-3317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "905 S MAIN ST",
"address_2": "SUITE 102",
"city": "MANSFIELD",
"state": "MA",
"postal_code": "020483149",
"telephone_number": "508-337-3307",
"fax_number": "508-337-3317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOREAU",
"first_name": "ROBERT",
"middle_name": "J",
"name_prefix": "Dr.",
"name_suffix": "Sr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-09",
"last_updated": "2016-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MA",
"license": "18512",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "X12178",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2016; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.