NPIMap

Organization Active NPI

David M. Petrarca, DDS & Sungyon Bang, DMD, P.C.

  • Pediatric Dentistry
  • Medford, MA
National Provider Identifier
1316915788
Registry record updated Jan 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
DAVID M. PETRARCA, DDS & SUNGYON BANG, DMD, P.C.
Practice address
80 High St
Medford, MA 02155-3813
Phone
(781) 391-8300
NPI assigned
Mar 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2020

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

Authorized official

Name
Dr. David Michael Petrarca, D.D.S.
Title
President
Phone
(781) 391-8300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X MA Primary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X MA

Addresses

Primary practice location

80 High St
Medford, MA 02155-3813

Mailing address

80 High St
Medford, MA 02155-3813
Phone (781) 391-8300

Other practice location 1

175 Littleton Rd
Westford, MA 01886-3196
Phone (978) 392-9800

National Provider Directory

National Provider Directory
Tax ID family
Childrens Dental Associates Westford3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579132800000",
    "number": "1316915788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 HIGH ST",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553813",
            "telephone_number": "781-391-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 HIGH ST",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553813",
            "telephone_number": "781-391-8300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "175 Littleton Rd",
            "address_purpose": "LOCATION",
            "city": "Westford",
            "state": "MA",
            "postal_code": "018863196",
            "country_code": "US",
            "telephone_number": "978-392-9800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DAVID M. PETRARCA, DDS & SUNGYON BANG, DMD, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-10",
        "last_updated": "2020-01-16",
        "certification_date": "2020-01-16",
        "status": "A",
        "authorized_official_last_name": "PETRARCA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-391-8300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MA",
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 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.

Verify at the official NPI Registry.