NPIMap

Organization Active NPI

Phoenix PC

  • General Practice Dentistry
  • Brockton, MA
National Provider Identifier
1275720971
Registry record updated Sep 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
13263 Issued in MA
Legal business name
PHOENIX PC
Practice address
165 Westgate Dr
Brockton, MA 02301-1821
Phone
(781) 335-8355
NPI assigned
Sep 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2007

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

Authorized official

Name
Peter Mortelliti
Title
Owner
Phone
(315) 454-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 13263 MA Primary

Addresses

Primary practice location

165 Westgate Dr
Brockton, MA 02301-1821

Mailing address

281 Sanders Creek Pkwy
East Syracuse, NY 13057-1307
Phone (315) 454-6000

National Provider Directory

National Provider Directory
Tax ID family
Smile Dental Dentures PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1190851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190851200000",
    "number": "1275720971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "281 SANDERS CREEK PKWY",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130571307",
            "telephone_number": "315-454-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 WESTGATE DR",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023011821",
            "telephone_number": "781-335-8355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-27",
        "last_updated": "2007-09-27",
        "status": "A",
        "authorized_official_last_name": "MORTELLITI",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-454-6000"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "13263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2007; 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.