Mikhail Shulkin DDS PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

20431 Issued in MA

Legal business name

MIKHAIL SHULKIN DDS PC

Doing business as

Moody Street Dental

Practice address

509 Moody Street
Waltham, MA 02453

Phone

(781) 894-0889

Fax

(781) 891-6857

NPI assigned

May 3, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Mikhail Shlkinu, DDS

Title

Dentist Owner

Phone

(781) 894-0889

Specialties & licenses 1

Addresses

Other names 1

• Moody Street Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Shulkin, DDS

  • Dentist
  • Waltham, MA
  • NPI 1801804174
  NPD (past)

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356563035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 MOODY STREET",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "02453",
            "telephone_number": "781-894-0889",
            "fax_number": "781-891-6857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 MOODY STREET",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "02453",
            "telephone_number": "781-894-0889",
            "fax_number": "781-891-6857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIKHAIL SHULKIN DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHLKINU",
        "authorized_official_first_name": "MIKHAIL",
        "authorized_official_title_or_position": "DENTIST OWNER",
        "authorized_official_telephone_number": "781-894-0889",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "20431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moody Street Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sidney Michaux, DPT
• Amanda Rose Michel, PT, DPT
• Guy-Smarth Michel
• Tatjana Micunovic, MS
• Mary Mikes
• Milestones Inc
• Milestones, Inc.
• Milestones, Inc.
• Milestones, Inc.
• Milestones, Inc.

• General Practice Dentistry in Waltham, MA
• Providers in Waltham, 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 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.