NPIMap

Organization Active NPI

Everett Childrens' Dental Center PC

  • Dental Clinic/Center
  • Everett, MA
National Provider Identifier
1407052830
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
19582 Issued in MA
Legal business name
EVERETT CHILDRENS' DENTAL CENTER PC
Practice address
186 Elm St
Everett, MA 02149-5222
Phone
(617) 389-2112
Fax
(617) 389-5885
NPI assigned
Jun 22, 2007
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
Mr. Chris Thach
Title
Office Manager
Phone
(617) 389-2112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 19582 MA Primary

Addresses

Primary practice location

186 Elm St
Everett, MA 02149-5222

Mailing address

186 Elm St
Everett, MA 02149-5222
Phone (617) 389-2112

National Provider Directory

National Provider Directory

Locations

186 Elm St
Everett, MA 02149
Phone (617) 389-2112

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1182470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407052830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "186 ELM ST",
            "city": "EVERETT",
            "state": "MA",
            "postal_code": "021495222",
            "telephone_number": "617-389-2112",
            "fax_number": "617-389-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "186 ELM ST",
            "city": "EVERETT",
            "state": "MA",
            "postal_code": "021495222",
            "telephone_number": "617-389-2112",
            "fax_number": "617-389-5885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERETT CHILDRENS' DENTAL CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "THACH",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "617-389-2112",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MA",
            "license": "19582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, 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.