NPIMap

Organization Active NPI

For All Ages Dental Associates

  • Dentist
  • Brockton, MA
National Provider Identifier
1396123642
Registry record updated Jan 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
20981 Issued in MA
Legal business name
FOR ALL AGES DENTAL ASSOCIATES
Practice address
478 Torrey St
Suite 1
Brockton, MA 02301-4696
Phone
(508) 586-1800
NPI assigned
May 7, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2016

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

Authorized official

Name
Jenieve Paul, DMD
Title
Owner Sole MBR
Phone
(508) 586-1800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 20981 MA Primary

Addresses

Primary practice location

478 Torrey St
Suite 1
Brockton, MA 02301-4696

Mailing address

478 Torrey St
Suite 1
Brockton, MA 02301
Phone (508) 586-1800

Other identifiers 1

IdentifierTypeStateIssuer
9902958MedicaidMA

Other names 1

  • For All Ages Dental Associates Doing business as

National Provider Directory

National Provider Directory

Locations

478 Torrey St
Ste 1
Brockton, MA 02301
Phone (508) 586-1800

NPI Registry JSON

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

{
    "created_epoch": "1430956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451952000000",
    "number": "1396123642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "478 TORREY ST",
            "address_2": "SUITE 1",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "02301",
            "telephone_number": "508-586-1800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "478 TORREY ST",
            "address_2": "SUITE 1",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023014696",
            "telephone_number": "508-586-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOR ALL AGES DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-07",
        "last_updated": "2016-01-05",
        "status": "A",
        "authorized_official_last_name": "PAUL",
        "authorized_official_first_name": "JENIEVE",
        "authorized_official_title_or_position": "OWNER SOLE MBR",
        "authorized_official_telephone_number": "508-586-1800",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "20981",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9902958",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "For All Ages Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2016; 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.