Active NPI
Kelly Gwen Bliss
- Dentist
- Milford, MA
National Provider Identifier
1245970839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN1859382
- Practice address
- 128 Medway Rd Ste 2&3
Milford, MA 01757-2915 - Phone
- (781) 325-1091
- NPI assigned
- Mar 31, 2022
- Last updated
- Feb 7, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | DN1859382 | MA | Primary |
Addresses
Primary practice location
128 Medway Rd Ste 2&3
Milford, MA 01757-2915
Mailing address
121 Linden St
Douglas, MA 01516-2467
Phone (508) 404-6751
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1859382 | MA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Milford Dentist Office, PC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675728000000",
"number": "1245970839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "121 LINDEN ST",
"city": "DOUGLAS",
"state": "MA",
"postal_code": "015162467",
"telephone_number": "508-404-6751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "128 MEDWAY RD STE 2&3",
"city": "MILFORD",
"state": "MA",
"postal_code": "017572915",
"telephone_number": "781-325-1091"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLISS",
"first_name": "KELLY",
"middle_name": "GWEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-31",
"last_updated": "2023-02-07",
"certification_date": "2023-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DN1859382",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.