NPIMap

Organization Active NPI

Eugene a Mickey, DMD, MPH, PC

  • Pediatric Dentistry
  • Stoneham, MA
National Provider Identifier
1396829180
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
14275 Issued in MA
Legal business name
EUGENE A MICKEY, DMD, MPH, PC
Practice address
67 Montvale Ave
Suite 101
Stoneham, MA 02180-3618
Phone
(781) 279-2400
Fax
(781) 279-4640
NPI assigned
Oct 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Lisa A Field, CDPMA
Title
Office Manager
Phone
(781) 279-2400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 14275 MA Primary

Addresses

Primary practice location

67 Montvale Ave
Suite 101
Stoneham, MA 02180-3618

Mailing address

67 Montvale Ave
Suite 101
Stoneham, MA 02180-3618
Phone (781) 279-2400

Other identifiers 3

IdentifierTypeStateIssuer
38861OtherMAHPHC
659373OtherPAUNITED CONCORDIA
X10967OtherMABCBSMA

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 4

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": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396829180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 MONTVALE AVE",
            "address_2": "SUITE 101",
            "city": "STONEHAM",
            "state": "MA",
            "postal_code": "021803618",
            "telephone_number": "781-279-2400",
            "fax_number": "781-279-4640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 MONTVALE AVE",
            "address_2": "SUITE 101",
            "city": "STONEHAM",
            "state": "MA",
            "postal_code": "021803618",
            "telephone_number": "781-279-2400",
            "fax_number": "781-279-4640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EUGENE A MICKEY, DMD, MPH, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FIELD",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "781-279-2400",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CDPMA"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MA",
            "license": "14275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HPHC",
            "identifier": "38861",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "659373",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSMA",
            "identifier": "X10967",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stoneham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.