Idg Boston PO Square Dental PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

IDG BOSTON PO SQUARE DENTAL PC

Practice address

10 Post Office SQ Ste 655
Boston, MA 02109-4603

Phone

(617) 423-6777

Fax

(617) 622-1548

NPI assigned

Nov 1, 2023

Last updated

Nov 1, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Heejeong Son, DMDNPI 1770079485

Title

President

Phone

(617) 485-4752

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Heejeong Son, DMD

  • General Practice Dentistry
  • Boston, MA
  • NPI 1770079485
  NPD Authorized official
• Dimitris Zourdos, DMD

  • General Practice Dentistry
  • Boston, MA
  • NPI 1356481857
  NPD (past)

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

{
    "created_epoch": "1698796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698796800000",
    "number": "1346013414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1996 CENTRE ST STE 201",
            "city": "WEST ROXBURY",
            "state": "MA",
            "postal_code": "021323330",
            "telephone_number": "617-221-8000",
            "fax_number": "617-531-2081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 POST OFFICE SQ STE 655",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021094603",
            "telephone_number": "617-423-6777",
            "fax_number": "617-622-1548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDG BOSTON PO SQUARE DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-01",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A",
        "authorized_official_last_name": "SON",
        "authorized_official_first_name": "HEEJEONG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-485-4752",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Esemuede Henry Idada
• Alexander John Phelan Idarraga
• Lucy Elizabeth Ide
• Identity and Mental Health Project LLC
• Idg Boston High Street Dental PC
• Jared Thomas Iding, MD
• Samir Idjeri
• Randy Keegan Idler, MD
• Azza H Idris, MD,PHD
• Henrietta Imade Idumwonyi, BSN, RN

• General Practice Dentistry in Boston, MA
• Providers in Boston, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; 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.