Active NPI
Bahram Ghassemi, DMD
- Orthodontics and Dentofacial Orthopedics Dentistry
- Boston, MA
National Provider Identifier
1356351696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 13913
- Practice address
- 68 New Edgerly Rd
Boston, MA 02115 - Phone
- (617) 262-5880
- Fax
- (617) 859-8804
- NPI assigned
- Aug 9, 2006
- Last updated
- Feb 19, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 13913 | MA | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 13913 | MA | Primary |
Addresses
Primary practice location
68 New Edgerly Rd
Boston, MA 02115
Mailing address
68 New Edgerly Rd
Boston, MA 02115
Phone (617) 262-5880
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100437 | Other | MA | DELTA DENTAL |
| X10762 | Other | MA | BLUE CROSS BLUE SHIELD |
| 0268631 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13913 | MA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Richard D Carr DDS | Pediatric Dentistry | Past | Accepting new patients |
| Diba Dastajerdi DMD PC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Pediatric Dentistry
- Boston, MA
- NPI 1124173612
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361232000000",
"number": "1356351696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "68 NEW EDGERLY RD",
"city": "BOSTON",
"state": "MA",
"postal_code": "02115",
"telephone_number": "617-262-5880",
"fax_number": "617-859-8804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "68 NEW EDGERLY RD",
"city": "BOSTON",
"state": "MA",
"postal_code": "02115",
"telephone_number": "617-262-5880",
"fax_number": "617-859-8804"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHASSEMI",
"first_name": "BAHRAM",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2013-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MA",
"license": "13913",
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MA",
"license": "13913",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DELTA DENTAL",
"identifier": "100437",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "X10762",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0268631",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 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.