NPIMap

Organization Active NPI

Stoneham Pediatric Dental Associates, PC

  • Pediatric Dentistry
  • Stoneham, MA
National Provider Identifier
1225574577
Registry record updated Jan 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DN1855141 Issued in MA
Legal business name
STONEHAM PEDIATRIC DENTAL ASSOCIATES, PC
Practice address
67 Montvale Ave
Suite 101
Stoneham, MA 02180-3618
Phone
(781) 279-2400
Fax
(781) 279-4640
NPI assigned
Jan 10, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2017

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

Authorized official

Name
Dr. Pushpak Patel
Title
President
Phone
(857) 919-2273

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DN1855141 MA
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X DN1855141 MA Primary
Dental HygienistGroup: 193200000X MULTI-SPECIALTY GROUP 124Q00000X DN1855141 MA

Addresses

Primary practice location

67 Montvale Ave
Suite 101
Stoneham, MA 02180-3618

Mailing address

67 Montvale Ave
Suite 101
Stoneham, MA 02180-3618
Phone (781) 279-2400

Other names 1

  • Dr. Mickey's Pediatric and Orthodontic Specialists Doing business as

National Provider Directory

National Provider Directory

Locations

67 Montvale Ave
Ste 101
Stoneham, MA 02180
Phone (781) 279-2400

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1484006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484006400000",
    "number": "1225574577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 MONTVALE AVE",
            "address_2": "SUITE 101",
            "city": "STONEHAM",
            "state": "MA",
            "postal_code": "021803618",
            "telephone_number": "781-279-2400",
            "fax_number": "781-279-4640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 MONTVALE AVE",
            "address_2": "SUITE 101",
            "city": "STONEHAM",
            "state": "MA",
            "postal_code": "021803618",
            "telephone_number": "781-279-2400",
            "fax_number": "781-279-4640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONEHAM PEDIATRIC DENTAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-10",
        "last_updated": "2017-01-10",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "PUSHPAK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "857-919-2273",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1855141",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MA",
            "license": "DN1855141",
            "primary": true
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": "MA",
            "license": "DN1855141",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Mickey's Pediatric and Orthodontic Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stoneham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.