Active NPI
Thomas Head Raddall IV, DDS
- Dentist
- Boston, MA
National Provider Identifier
1295347342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DL14399
- Practice address
- 300 Longwood Avenue
Boston Children'S Hospital - Department of Dentistry
Boston, MA 02115 - Phone
- (617) 355-6571
- NPI assigned
- Aug 20, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DL14399 | MA | Primary |
Addresses
Primary practice location
300 Longwood Avenue
Boston Children'S Hospital - Department of Dentistry
Boston, MA 02115
Mailing address
80 Fenwood Road
Suite 710
Boston, MA 02115
Phone (902) 350-1717
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 |
|---|---|---|---|
| DL14399 | MA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597881600000",
"number": "1295347342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "80 FENWOOD ROAD",
"address_2": "SUITE 710",
"city": "BOSTON",
"state": "MA",
"postal_code": "02115",
"telephone_number": "902-350-1717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 LONGWOOD AVENUE",
"address_2": "BOSTON CHILDREN'S HOSPITAL - DEPARTMENT OF DENTISTRY",
"city": "BOSTON",
"state": "MA",
"postal_code": "02115",
"telephone_number": "617-355-6571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RADDALL",
"first_name": "THOMAS",
"middle_name": "HEAD",
"name_prefix": "Dr.",
"name_suffix": "IV",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-08-20",
"last_updated": "2020-08-20",
"certification_date": "2020-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DL14399",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.