NPIMap

Organization Active NPI

El Shaddai Dental Associates Mattapan PC

  • Dentist
  • Mattapan, MA
National Provider Identifier
1376919696
Registry record updated Aug 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN19621 Issued in MA
Legal business name
EL SHADDAI DENTAL ASSOCIATES MATTAPAN PC
Practice address
542 River St
Mattapan, MA 02126-3014
Phone
(617) 298-1955
Fax
(617) 296-6004
NPI assigned
Aug 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2015

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

Authorized official

Name
Dr. Anthony O Olatunji, DMD
Title
Owner
Phone
(617) 298-1955

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DN19621 MA Primary

Addresses

Primary practice location

542 River St
Mattapan, MA 02126-3014

Mailing address

542 River St
Mattapan, MA 02126-3014
Phone (617) 298-1955

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1440028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440028800000",
    "number": "1376919696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "542 RIVER ST",
            "city": "MATTAPAN",
            "state": "MA",
            "postal_code": "021263014",
            "telephone_number": "617-298-1955",
            "fax_number": "617-296-6004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "542 RIVER ST",
            "city": "MATTAPAN",
            "state": "MA",
            "postal_code": "021263014",
            "telephone_number": "617-298-1955",
            "fax_number": "617-296-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL SHADDAI DENTAL ASSOCIATES MATTAPAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-20",
        "last_updated": "2015-08-20",
        "status": "A",
        "authorized_official_last_name": "OLATUNJI",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-298-1955",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN19621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mattapan, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2015; 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.