NPIMap

Organization Active NPI

Matthew R. Fantasia, D.M.D., P.C.

  • General Practice Dentistry
  • Wellesley, MA
National Provider Identifier
1386995397
Registry record updated Oct 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN 20441 Issued in MA
Legal business name
MATTHEW R. FANTASIA, D.M.D., P.C.
Practice address
372 Washington St
Wellesley, MA 02481-6202
Phone
(781) 235-1146
Fax
(781) 235-9195
NPI assigned
Oct 1, 2012
Last updated
Oct 15, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2012

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

Authorized official

Name
Dr. Matthew R. Fantasia, D.M.D.NPI 1376752840
Title
President
Phone
(781) 235-1146

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X DN 20441 MA Primary
ProsthodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0700X DN 14506 MA

Addresses

Primary practice location

372 Washington St
Wellesley, MA 02481-6202

Mailing address

372 Washington St
Wellesley, MA 02481-6202
Phone (781) 235-1146

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1349049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350259200000",
    "number": "1386995397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "372 WASHINGTON ST",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024816202",
            "telephone_number": "781-235-1146",
            "fax_number": "781-235-9195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "372 WASHINGTON ST",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024816202",
            "telephone_number": "781-235-1146",
            "fax_number": "781-235-9195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW R. FANTASIA, D.M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-01",
        "last_updated": "2012-10-15",
        "status": "A",
        "authorized_official_last_name": "FANTASIA",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-235-1146",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN 20441",
            "primary": true
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": "MA",
            "license": "DN 14506",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wellesley, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; 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.