Active NPI
Charles Sutera III, DMD
- General Practice Dentistry
- Waltham, MA
National Provider Identifier
1295013662
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN1855853
- Practice address
- 75 3Rd Ave
Waltham, MA 02451-7549 - Phone
- (781) 487-1111
- NPI assigned
- Aug 2, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DEN4207 | ME | |
| General Practice Dentistry | 1223G0001X | DN1855853 | MA | Primary |
Addresses
Primary practice location
75 3Rd Ave
Waltham, MA 02451-7549
Mailing address
20 Roosevelt Rd
Medford, MA 02155-2519
Phone (978) 314-8974
Other practice location 1
171 Maine Mall Rd
South Portland, ME 04106-2310
Phone (207) 775-1551
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 |
|---|---|---|---|
| DN1855853 | MA | MD | General Practice Dentistry |
| DEN4207 | ME | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aesthetic Smile Reconstruction PC | Past | Accepting new patients | |
| Oakes, LLC | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Aesthetic Smile Reconstruction
- Dental Clinic/Center
- Waltham, MA
- NPI 1437621224
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545436800000",
"number": "1295013662",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 ROOSEVELT RD",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021552519",
"telephone_number": "978-314-8974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 3RD AVE",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024517549",
"telephone_number": "781-487-1111"
}
],
"practiceLocations": [
{
"address_1": "171 Maine Mall Rd",
"address_purpose": "LOCATION",
"city": "South Portland",
"state": "ME",
"postal_code": "041062310",
"country_code": "US",
"telephone_number": "207-775-1551",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SUTERA",
"first_name": "CHARLES",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-08-02",
"last_updated": "2018-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "ME",
"license": "DEN4207",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "DN1855853",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.