NPIMap

Organization Active NPI

Dr. Suresh K Naidu DDS

  • Dentist
  • Roxbury, MA
National Provider Identifier
1417117987
Registry record updated Jun 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
13632 Issued in MA
Legal business name
DR. SURESH K NAIDU DDS
Practice address
156 Dudley St
Roxbury, MA 02119-3232
Phone
(617) 445-7050
NPI assigned
Jun 9, 2008
Last updated
Jun 9, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2008

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

Authorized official

Name
Dr. Suresh K NaiduNPI 1922154301
Title
Owner
Phone
(617) 445-7050

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 13632 MA Primary

Addresses

Primary practice location

156 Dudley St
Roxbury, MA 02119-3232

Mailing address

156 Dudley St
Roxbury, MA 02119-3232

Other identifiers 1

IdentifierTypeStateIssuer
0253049MedicaidMA

National Provider Directory

National Provider Directory

Locations

156 Dudley St
Roxbury, MA 02119
Phone (617) 445-7050

Practitioners & affiliated clinicians

Practitioners 2

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": "1212969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212969600000",
    "number": "1417117987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "156 DUDLEY ST",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021193232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 DUDLEY ST",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021193232",
            "telephone_number": "617-445-7050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. SURESH K NAIDU DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-09",
        "last_updated": "2008-06-09",
        "status": "A",
        "authorized_official_last_name": "NAIDU",
        "authorized_official_first_name": "SURESH",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-445-7050",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "13632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0253049",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roxbury, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; 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.