NPIMap

Organization Active NPI

Sambath Keo, DMD, Inc

  • General Practice Dentistry
  • Lowell, MA
National Provider Identifier
1366614174
Registry record updated Apr 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
17863 Issued in MA
Legal business name
SAMBATH KEO, DMD, INC
Practice address
50 Wood St
Lowell, MA 01851-1519
Phone
(978) 441-9991
Fax
(978) 441-9996
NPI assigned
Apr 1, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2008

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

Authorized official

Name
Dr. Sambath Keo
Title
President
Phone
(978) 441-9991

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 17863 MA Primary

Addresses

Primary practice location

50 Wood St
Lowell, MA 01851-1519

Mailing address

50 Wood St
Lowell, MA 01851-1519
Phone (978) 441-9991

Other identifiers 1

IdentifierTypeStateIssuer
0273732MedicaidMA

National Provider Directory

National Provider Directory

Locations

50 Wood St
Lowell, MA 01851
Phone (978) 441-9991

Practitioners & affiliated clinicians

Practitioners 1

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": "1207008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207008000000",
    "number": "1366614174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 WOOD ST",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "018511519",
            "telephone_number": "978-441-9991",
            "fax_number": "978-441-9996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 WOOD ST",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "018511519",
            "telephone_number": "978-441-9991",
            "fax_number": "978-441-9996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMBATH KEO, DMD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-01",
        "last_updated": "2008-04-01",
        "status": "A",
        "authorized_official_last_name": "KEO",
        "authorized_official_first_name": "SAMBATH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "978-441-9991",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "17863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0273732",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lowell, MA

Sources for this page

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