NPIMap

Organization Active NPI

Waverley Oaks Dental Care Specialists LLC

  • Pediatric Dentistry
  • Waltham, MA
National Provider Identifier
1336282300
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
18464 Issued in MA
Legal business name
WAVERLEY OAKS DENTAL CARE SPECIALISTS LLC
Practice address
411 Waverley Oaks Rd
BLDG #3, Ste. 318
Waltham, MA 02452-8448
Phone
(781) 647-0022
Fax
(781) 647-1122
NPI assigned
Feb 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Shahin Soli Sagafi, DMDNPI 1508937673
Title
Owner
Phone
(781) 647-0022

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
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 18464 MA Primary

Addresses

Primary practice location

411 Waverley Oaks Rd
BLDG #3, Ste. 318
Waltham, MA 02452-8448

Mailing address

411 Waverley Oaks Rd
BLDG #3, Ste. 318
Waltham, MA 02452-8448
Phone (781) 647-0022

Other identifiers 1

IdentifierTypeStateIssuer
X12212OtherMABLUE CROSS BLUE SHIELDS

National Provider Directory

National Provider Directory

Locations

411 Waverley Oaks Rd
Bldg 3
Waltham, MA 02452
Phone (781) 891-3706

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": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336282300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 WAVERLEY OAKS RD",
            "address_2": "BLDG #3, STE. 318",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024528448",
            "telephone_number": "781-647-0022",
            "fax_number": "781-647-1122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 WAVERLEY OAKS RD",
            "address_2": "BLDG #3, STE. 318",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024528448",
            "telephone_number": "781-647-0022",
            "fax_number": "781-647-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAVERLEY OAKS DENTAL CARE SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SAGAFI",
        "authorized_official_first_name": "SHAHIN",
        "authorized_official_middle_name": "SOLI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-647-0022",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MA",
            "license": "18464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELDS",
            "identifier": "X12212",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waltham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.