NPIMap

Organization Active NPI

Massachusetts General Physicians Organization

Doing business as MGH Dental Group

  • Dentist
  • Boston, MA
National Provider Identifier
1265583199
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
16139 Issued in MA
Legal business name
MASSACHUSETTS GENERAL PHYSICIANS ORGANIZATION
Doing business as
MGH Dental Group
Practice address
165 Cambridge St
Suite 401
Boston, MA 02114-2783
Phone
(617) 726-1076
Fax
(617) 724-6681
NPI assigned
Jan 16, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Agnes Lau, DMDNPI 1780675819
Title
Director, MGH Dental Group
Phone
(617) 726-1076

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 16139 MA Primary

Addresses

Primary practice location

165 Cambridge St
Suite 401
Boston, MA 02114-2783

Mailing address

165 Cambridge St
Suite 401
Boston, MA 02114-2783
Phone (617) 726-1076

Other identifiers 3

IdentifierTypeStateIssuer
774OtherMADELTA DENTAL GROUP NUMBER
9762779MedicaidMA
1364OtherMADELTA DENTAL SPECIALIST

Other names 1

  • MGH Dental Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Edwin Lee Carter MD15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

165 Cambridge St
Ste 401
Boston, MA 02114
Phone (617) 726-1076

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265583199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 CAMBRIDGE ST",
            "address_2": "SUITE 401",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142783",
            "telephone_number": "617-726-1076",
            "fax_number": "617-724-6681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 CAMBRIDGE ST",
            "address_2": "SUITE 401",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142783",
            "telephone_number": "617-726-1076",
            "fax_number": "617-724-6681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASSACHUSETTS GENERAL PHYSICIANS ORGANIZATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LAU",
        "authorized_official_first_name": "AGNES",
        "authorized_official_title_or_position": "DIRECTOR, MGH DENTAL GROUP",
        "authorized_official_telephone_number": "617-726-1076",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "16139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL GROUP NUMBER",
            "identifier": "774",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9762779",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL SPECIALIST",
            "identifier": "1364",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MGH Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.