NPIMap

Organization Active NPI

All Dental of Revere

  • Dentist
  • Revere, MA
National Provider Identifier
1285005207
Registry record updated Oct 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
18643 Issued in MA
Legal business name
ALL DENTAL OF REVERE
Practice address
370 Broadway
Revere, MA 02151-5016
Phone
(617) 547-0700
NPI assigned
Oct 16, 2015
Last updated
Oct 16, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2015

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

Authorized official

Name
Dr. Andrey Mazo
Title
President
Phone
(617) 285-6414

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 18643 MA Primary

Addresses

Primary practice location

370 Broadway
Revere, MA 02151-5016

Mailing address

370 Broadway
Revere, MA 02151-5016

Other identifiers 1

IdentifierTypeStateIssuer
0277975MedicaidMA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1444953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444953600000",
    "number": "1285005207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "370 BROADWAY",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021515016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 BROADWAY",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021515016",
            "telephone_number": "617-547-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALL DENTAL OF REVERE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-16",
        "last_updated": "2015-10-16",
        "status": "A",
        "authorized_official_last_name": "MAZO",
        "authorized_official_first_name": "ANDREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-285-6414",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "18643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0277975",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Revere, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2015; 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.