NPIMap

Organization Active NPI

Groton Wellness Family Dentistry,LLC

  • Dental Clinic/Center
  • Groton, MA
National Provider Identifier
1306276969
Registry record updated Nov 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
13901 Issued in MA
Legal business name
GROTON WELLNESS FAMILY DENTISTRY,LLC
Practice address
495 Main St
Groton, MA 01450-4253
Phone
(978) 449-9919
Fax
(978) 449-9929
NPI assigned
Nov 19, 2013
Last updated
Nov 19, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2013

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

Authorized official

Name
Mr. G.Robert Evans, DMD
Title
Owner
Phone
(978) 449-9919

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 13901 MA Primary

Addresses

Primary practice location

495 Main St
Groton, MA 01450-4253

Mailing address

495 Main St
Groton, MA 01450-4253
Phone (978) 449-9919

National Provider Directory

National Provider Directory

Locations

495 Main St
Groton, MA 01450
Phone (978) 449-9919

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1384819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384819200000",
    "number": "1306276969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 MAIN ST",
            "city": "GROTON",
            "state": "MA",
            "postal_code": "014504253",
            "telephone_number": "978-449-9919",
            "fax_number": "978-449-9929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 MAIN ST",
            "city": "GROTON",
            "state": "MA",
            "postal_code": "014504253",
            "telephone_number": "978-449-9919",
            "fax_number": "978-449-9929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GROTON WELLNESS FAMILY DENTISTRY,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-19",
        "last_updated": "2013-11-19",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "G.ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "978-449-9919",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MA",
            "license": "13901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Groton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2013; 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.