Individual provider Active NPI

Donavon Khosrow Aroni

  • Orofacial Pain Dentistry
  • Boston, MA
National Provider Identifier
1295150571
Registry record updated Mar 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orofacial Pain DentistryTaxonomy code 1223X2210X
License
DF11938 Issued in MA
Practice address
1 Kneeland St # 601
Boston, MA 02111-1527
Phone
(617) 636-6817
NPI assigned
Feb 24, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DF11059 MA
Orofacial Pain Dentistry 1223X2210X DF11938 MA Primary

Addresses

Primary practice location

1 Kneeland St # 601
Boston, MA 02111-1527

Mailing address

1 Kneeland St # 601
Boston, MA 02111-1527
Phone (617) 636-3743

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170118000231 MA Practitioner - DentistPractitioner - Oral Surgery 5698057180 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dentist
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Trustees of Tufts CollegeGroup PAC ID 3779522628, 15 clinicians

Practice addresses (Care Compare)

1 Kneeland St
Boston, MA 02111-1527
Phone (617) 636-6828

200 Harrison Ave
2CD Floor
Boston, MA 02111-1527

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DF11059MAMDDentist
DF11938MAMDOrofacial Pain Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Tufts College Orofacial Pain CurrentSince Jan 27, 2017 Accepting new patients
Trustees of Tufts College CurrentSince Jan 27, 2017 Accepting new patients
Trustees of Tufts College Past Accepting new patients

Locations

1 Kneeland St
#6
Boston, MA 02111

1 Kneeland St
Fl 6
Boston, MA 02111
Phone (617) 636-3932

1 Kneeland St
Boston, MA 02111
Phone (617) 636-6515

1 Kneeland St
#601
Boston, MA 02111
Phone (617) 636-6817

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1393200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677628800000",
    "number": "1295150571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 KNEELAND ST # 601",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021111527",
            "telephone_number": "617-636-3743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 KNEELAND ST # 601",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021111527",
            "telephone_number": "617-636-6817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARONI",
        "first_name": "DONAVON KHOSROW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-24",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DF11059",
            "primary": false
        },
        {
            "code": "1223X2210X",
            "taxonomy_group": "",
            "desc": "Dentist, Orofacial Pain",
            "state": "MA",
            "license": "DF11938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.