Northgate Dental Center, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

18100 Issued in MA

Legal business name

NORTHGATE DENTAL CENTER, PC

Practice address

1985 Main St Ste 1
Springfield, MA 01103-1072

Phone

(413) 747-0400

Fax

(413) 747-2440

NPI assigned

Mar 11, 2007

Organization subpart

No

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

Authorized official

Name

William Malave-Vidal, DMDNPI 1326170861

Title

President

Phone

(413) 747-0400

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• William Malave-Vidal, DMD

  • General Practice Dentistry
  • Springfield, MA
  • NPI 1326170861
  NPD (past) Authorized official

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

{
    "created_epoch": "1173571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275665705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2218",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011012218",
            "telephone_number": "413-747-0400",
            "fax_number": "413-747-2440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1985 MAIN ST STE 1",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011031072",
            "telephone_number": "413-747-0400",
            "fax_number": "413-747-2440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHGATE DENTAL CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MALAVE-VIDAL",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "413-747-0400",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "18100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9753371",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northeast Orthopaedic Alliance PLLC
• Northend Medical Associates Inc
• Northern Educational Service Inc.
• Northern Educational Services, Inc,
• Northern Pain MGM Ctr
• Northgate Spine & Injury Center
• Jessica Northup
• Krystal-Lynn Northup
• Jennifer L Norton, FNP-C
• Mary Norton, MSW

• General Practice Dentistry in Springfield, MA
• Providers in Springfield, MA by specialty
• General Practice Dentistry in Massachusetts

• 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.