NPIMap

Organization Active NPI

Gabriel Boustani DMD PC

  • Periodontics
  • Brookline, MA
National Provider Identifier
1306235064
Registry record updated Jan 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
21631 Issued in MA
Legal business name
GABRIEL BOUSTANI DMD PC
Practice address
1540 Beacon St
Brookline, MA 02446-2215
Phone
(617) 738-1950
NPI assigned
Jan 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2015

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

Authorized official

Name
Dr. Gabriel Boustani, DMD, MSDNPI 1740216084
Title
President
Phone
(617) 640-4637

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X 21631 MA Primary

Addresses

Primary practice location

1540 Beacon St
Brookline, MA 02446-2215

Mailing address

140 Greenwood St
Newton, MA 02459-3013

National Provider Directory

National Provider Directory
Tax ID family
Gabriel Boustani DMD PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1421712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421971200000",
    "number": "1306235064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 GREENWOOD ST",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "024593013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 BEACON ST",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024462215",
            "telephone_number": "617-738-1950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GABRIEL BOUSTANI DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-20",
        "last_updated": "2015-01-23",
        "status": "A",
        "authorized_official_last_name": "BOUSTANI",
        "authorized_official_first_name": "GABRIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-640-4637",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MSD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MA",
            "license": "21631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookline, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2015; 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.