NPIMap

Organization Active NPI

Professional Dental Allaince of Massachusetts PLLC

Doing business as Innovative Dental

  • General Practice Dentistry
  • Boylston, MA
National Provider Identifier
1245878305
Registry record updated Dec 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PROFESSIONAL DENTAL ALLAINCE OF MASSACHUSETTS PLLC
Doing business as
Innovative Dental
Practice address
17 Main St
Boylston, MA 01505-1948
Phone
(508) 869-6388
NPI assigned
Dec 19, 2019
Last updated
Dec 19, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2019

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

Authorized official

Name
Andrew Matta
Title
Owner
Phone
(724) 698-2500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

17 Main St
Boylston, MA 01505-1948

Mailing address

11 S Mill St Ste 200
New Castle, PA 16101-3680

Other practice location 1

622 Main St
Shrewsbury, MA 01545-5639
Phone (508) 845-1156

Other practice location 2

119 S Main St
Leicester, MA 01524-1403
Phone (508) 892-4882

Other names 1

  • Innovative Dental Doing business as

National Provider Directory

National Provider Directory

Locations

17 Main St
Boylston, MA 01505
Phone (508) 869-6388

Practitioners & affiliated clinicians

Practitioners 4

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": "1576713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576713600000",
    "number": "1245878305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S MILL ST STE 200",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161013680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 MAIN ST",
            "city": "BOYLSTON",
            "state": "MA",
            "postal_code": "015051948",
            "telephone_number": "508-869-6388"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "622 Main St",
            "address_purpose": "LOCATION",
            "city": "Shrewsbury",
            "state": "MA",
            "postal_code": "015455639",
            "country_code": "US",
            "telephone_number": "508-845-1156",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "119 S Main St",
            "address_purpose": "LOCATION",
            "city": "Leicester",
            "state": "MA",
            "postal_code": "015241403",
            "country_code": "US",
            "telephone_number": "508-892-4882",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLAINCE OF MASSACHUSETTS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-19",
        "last_updated": "2019-12-19",
        "certification_date": "2019-12-19",
        "status": "A",
        "authorized_official_last_name": "MATTA",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "724-698-2500"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innovative Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boylston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2019; 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.