Poornima Mysore Vishwanath, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN1859211 Issued in MA

Practice address

314 Moody St
Waltham, MA 02453-5202

Phone

(781) 398-0000

NPI assigned

Sep 30, 2021

Last updated

Sep 30, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1632960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632960000000",
    "number": "1376215137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 FIFER LN",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024201231",
            "telephone_number": "512-674-5336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 MOODY ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024535202",
            "telephone_number": "781-398-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYSORE VISHWANATH",
        "first_name": "POORNIMA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-30",
        "last_updated": "2021-09-30",
        "certification_date": "2021-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1859211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wilson Musobya
• Shafa Mustafa
• Nasser Muzaaya, MD
• My Dental LLC
• Lindy Jill Myers, M.S. CCC-SLP
• Eugenia Naamon
• Agnes Nabaloga I
• Solome A Nabatanzi
• Therese M Nagovan, MOTR/L
• James G Nairus, MD

• Dentist in Waltham, MA
• Providers in Waltham, MA by specialty
• Dentist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2021; 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.