Greater Boston Oral Surgery and Dental Implant Center PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

GREATER BOSTON ORAL SURGERY AND DENTAL IMPLANT CENTER PLLC

Doing business as

Greater Boston Oral Surgery and Dental Implant Center

Practice address

101 Main St Ste 201
Medford, MA 02155-4530

Phone

(617) 875-7827

NPI assigned

Aug 18, 2025

Organization subpart

No

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

Authorized official

Name

Chad Hendricks

Title

Credentialing

Phone

(612) 859-0444

Specialties & licenses 1

Addresses

Other names 1

• Greater Boston Oral Surgery and Dental Implant Center Doing business as

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

{
    "created_epoch": "1755475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755475200000",
    "number": "1225915770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MAIN ST STE 201",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021554530",
            "telephone_number": "617-875-7827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MAIN ST STE 201",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021554530",
            "telephone_number": "617-875-7827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER BOSTON ORAL SURGERY AND DENTAL IMPLANT CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-18",
        "last_updated": "2025-08-18",
        "certification_date": "2025-08-18",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "612-859-0444"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greater Boston Oral Surgery and Dental Implant Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Grace Jotika DMD PC
• Brian John Grace, PMHNP-BC, MBA, RN
• Shawn Grace
• James Graham, PSY.D.
• Sara Grant, FNP
• Green Cab Co, Inc.
• Jaron Stephen Green
• Kaitlin Green, LICSW
• Ariel Dance Greenidge, LICSW
• Nike Konstantina Gregory, LICSW

• Oral and Maxillofacial Surgery (Dentist) in Medford, MA
• Providers in Medford, MA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2025; 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.