Active NPI
Laurie Manthos, D.M.D.
- Oral and Maxillofacial Surgery (Dentist)
- Worcester, MA
National Provider Identifier
1295941607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 16823
- Practice address
- 200 Lincoln St
Suite 1
Worcester, MA 01605-2528 - Phone
- (508) 752-2100
- Fax
- (508) 752-0304
- NPI assigned
- May 15, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 16823 | MA | Primary |
Addresses
Primary practice location
200 Lincoln St
Suite 1
Worcester, MA 01605-2528
Mailing address
200 Lincoln St
Suite 1
Worcester, MA 01605-2528
Phone (508) 752-2100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2022 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16823 | MA | MD | Oral and Maxillofacial Surgery (Dentist) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295941607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 LINCOLN ST",
"address_2": "SUITE 1",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016052528",
"telephone_number": "508-752-2100",
"fax_number": "508-752-0304"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 LINCOLN ST",
"address_2": "SUITE 1",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016052528",
"telephone_number": "508-752-2100",
"fax_number": "508-752-0304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANTHOS",
"first_name": "LAURIE",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "MA",
"license": "16823",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.