NPIMap

Organization Active NPI

Brockton Family Dental Inc.

  • Dentist
  • Brockton, MA
National Provider Identifier
1235212226
Registry record updated Mar 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
20758 Issued in MA
Legal business name
BROCKTON FAMILY DENTAL INC.
Practice address
4 Main St
Brockton, MA 02301-4027
Phone
(508) 587-7775
Fax
(508) 587-7799
NPI assigned
Oct 23, 2006
Last updated
Mar 5, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2012

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

Authorized official

Name
Dr. Sang Bae, M.D.NPI 1962566513
Title
Owner
Phone
(508) 587-7775

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 20758 MA Primary

Addresses

Primary practice location

4 Main St
Brockton, MA 02301-4027

Mailing address

4 Main St
Brockton, MA 02301-4027
Phone (508) 587-7775

Other identifiers 1

IdentifierTypeStateIssuer
9734180MedicaidMA

National Provider Directory

National Provider Directory

Locations

4 Main St
Brockton, MA 02301
Phone (508) 587-7775

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330905600000",
    "number": "1235212226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MAIN ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023014027",
            "telephone_number": "508-587-7775",
            "fax_number": "508-587-7799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MAIN ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023014027",
            "telephone_number": "508-587-7775",
            "fax_number": "508-587-7799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROCKTON FAMILY DENTAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2012-03-05",
        "status": "A",
        "authorized_official_last_name": "BAE",
        "authorized_official_first_name": "SANG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-587-7775",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "20758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9734180",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2012; 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.