NPIMap

Organization Active NPI

Western Mass Periodontics PC

  • Periodontics
  • Worcester, MA
National Provider Identifier
1295217065
Registry record updated Aug 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
WESTERN MASS PERIODONTICS PC
Practice address
65 Elm St
Worcester, MA 01609-2547
Phone
(508) 363-4400
NPI assigned
Aug 29, 2018
Organization subpart
Yes
Parent organization
WESTERN MASS PERIODONTICS PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 19, 2022

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

Authorized official

Name
Leah Ann Maylott
Title
Credentialing Administrator
Phone
(860) 874-8198

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0300X Primary

Addresses

Primary practice location

65 Elm St
Worcester, MA 01609-2547

Mailing address

65 Elm St
Worcester, MA 01609-2547
Phone (860) 874-8198

Other practice location 1

201 Boston Post Rd W Ste 409
Marlborough, MA 01752-4667
Phone (508) 393-0160

Other names 2

  • Northeast Periodontal Specialists Doing business as
  • Akram E. Rafla DMD, PC Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Western Mass Periodontics PC4 organizations share this tax ID, including this one
Part of
Western Mass Periodontics PC

Other organizations with this tax ID 3

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1535500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660867200000",
    "number": "1295217065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 ELM ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016092547",
            "telephone_number": "860-874-8198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 ELM ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016092547",
            "telephone_number": "508-363-4400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 Boston Post Rd W Ste 409",
            "address_purpose": "LOCATION",
            "city": "Marlborough",
            "state": "MA",
            "postal_code": "017524667",
            "country_code": "US",
            "telephone_number": "508-393-0160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WESTERN MASS PERIODONTICS PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTERN MASS PERIODONTICS PC",
        "enumeration_date": "2018-08-29",
        "last_updated": "2022-08-19",
        "certification_date": "2022-08-19",
        "status": "A",
        "authorized_official_last_name": "MAYLOTT",
        "authorized_official_first_name": "LEAH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CREDENTIALING ADMINISTRATOR",
        "authorized_official_telephone_number": "860-874-8198"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northeast Periodontal Specialists",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Akram E. Rafla DMD, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Akram E. Rafla DMD, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2022; 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.