NPIMap

Organization Active NPI

El Shaddai Dental

  • General Practice Dentistry
  • Randolph, MA
National Provider Identifier
1336266980
Registry record updated Jul 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
19621 Issued in MA
Legal business name
EL SHADDAI DENTAL
Practice address
1134 N Main St
Randolph, MA 02368-2130
Phone
(781) 986-8800
Fax
(781) 986-1600
NPI assigned
Mar 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2008

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

Authorized official

Name
Dr. Anthony Olatunji, D.M. DNPI 1932267390
Title
Owner
Phone
(781) 986-8800

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 19621 MA Primary

Addresses

Primary practice location

1134 N Main St
Randolph, MA 02368-2130

Mailing address

1134 N Main St
Randolph, MA 02368-2130
Phone (781) 986-8800

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1336266980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1134 N MAIN ST",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "023682130",
            "telephone_number": "781-986-8800",
            "fax_number": "781-986-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1134 N MAIN ST",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "023682130",
            "telephone_number": "781-986-8800",
            "fax_number": "781-986-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL SHADDAI DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2008-07-14",
        "status": "A",
        "authorized_official_last_name": "OLATUNJI",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-986-8800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M. D"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "19621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Randolph, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; 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.