NPIMap

Organization Active NPI

Periodontology Assoc

  • Periodontics
  • Concord, MA
National Provider Identifier
1407964901
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
13998 Issued in MA
Legal business name
PERIODONTOLOGY ASSOC
Practice address
290 Baker Ave
S103
Concord, MA 01742
Phone
(978) 369-5521
Fax
(978) 369-5591
NPI assigned
Aug 26, 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
Dr. Jeffrey B Freedman, DDSNPI 1942416276
Title
Owner
Phone
(978) 369-5521

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X 13998 MA Primary
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X 19000 MA

Addresses

Primary practice location

290 Baker Ave
S103
Concord, MA 01742

Mailing address

290 Baker Ave
S103
Concord, MA 01742
Phone (978) 369-5521

National Provider Directory

National Provider Directory

Locations

290 Baker Ave
Ste S103
Concord, MA 01742
Phone (978) 369-5521

Practitioners & affiliated clinicians

Practitioners 1

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": "1156550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407964901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 BAKER AVE",
            "address_2": "S103",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "01742",
            "telephone_number": "978-369-5521",
            "fax_number": "978-369-5591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 BAKER AVE",
            "address_2": "S103",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "01742",
            "telephone_number": "978-369-5521",
            "fax_number": "978-369-5591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTOLOGY ASSOC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FREEDMAN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "978-369-5521",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MA",
            "license": "13998",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MA",
            "license": "19000",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, 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.