Edgartown Dental Group LLC

Key facts

NPI: 1235657255
Entity type: Organization (NPI type 2)
Primary specialty: General Practice Dentistry 1223G0001X
Legal business name: EDGARTOWN DENTAL GROUP LLC
Practice address: 207 Upper Main St
Edgartown, MA 02539-5927
Phone: (508) 939-9000
NPI assigned: Aug 30, 2017
Organization subpart: No

Authorized official

Name: Bari Stern
Title: Admin Coordinator
Phone: (917) 696-4515

Practitioners 1

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

Glenn R Harris, DMD General Practice Dentistry · Edgartown, MA · NPI 1730205352

NPD (past) GENERAL PRACTICE

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Dentistry Group: 193400000X SINGLE SPECIALTY GROUP	1223G0001X			Yes

Addresses

Primary practice location

207 Upper Main St
Edgartown, MA 02539-5927

Mailing address

PO Box 9000
Edgartown, MA 02539-9000

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 30, 2017.

{
    "created_epoch": "1504051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504051200000",
    "number": "1235657255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9000",
            "city": "EDGARTOWN",
            "state": "MA",
            "postal_code": "025399000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 UPPER MAIN ST",
            "city": "EDGARTOWN",
            "state": "MA",
            "postal_code": "025395927",
            "telephone_number": "508-939-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGARTOWN DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-30",
        "last_updated": "2017-08-30",
        "status": "A",
        "authorized_official_last_name": "STERN",
        "authorized_official_first_name": "BARI",
        "authorized_official_title_or_position": "ADMIN COORDINATOR",
        "authorized_official_telephone_number": "917-696-4515"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgartown, MA

All providers in Edgartown, MA · General Practice Dentistry in Massachusetts

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2017. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.