NPIMap

Organization Active NPI

Merrimack Valley Cosmetic Dentistry, LLC

  • General Practice Dentistry
  • North Andover, MA
National Provider Identifier
1417292269
Registry record updated Mar 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
16194 Issued in MA
Legal business name
MERRIMACK VALLEY COSMETIC DENTISTRY, LLC
Practice address
565 Turnpike St
63A
North Andover, MA 01845-5922
Phone
(978) 683-8855
Fax
(978) 738-9687
NPI assigned
Dec 5, 2012
Last updated
Mar 7, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2017

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

Authorized official

Name
Dr. David Nicholas Bardwell, DMD, MSNPI 1629082441
Title
Sole Trustee
Phone
(978) 683-8855

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 16194 MA
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 16194 MA Primary

Addresses

Primary practice location

565 Turnpike St
63A
North Andover, MA 01845-5922

Mailing address

565 Turnpike St
63A
North Andover, MA 01845-5922
Phone (978) 683-8855

National Provider Directory

National Provider Directory

Locations

565 Turnpike St
#63A
North Andover, MA 01845
Phone (978) 683-8855

Practitioners & affiliated clinicians

Practitioners 1

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": "1354665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488844800000",
    "number": "1417292269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "565 TURNPIKE ST",
            "address_2": "63A",
            "city": "NORTH ANDOVER",
            "state": "MA",
            "postal_code": "018455922",
            "telephone_number": "978-683-8855",
            "fax_number": "978-738-9687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 TURNPIKE ST",
            "address_2": "63A",
            "city": "NORTH ANDOVER",
            "state": "MA",
            "postal_code": "018455922",
            "telephone_number": "978-683-8855",
            "fax_number": "978-738-9687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERRIMACK VALLEY COSMETIC DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-05",
        "last_updated": "2017-03-07",
        "status": "A",
        "authorized_official_last_name": "BARDWELL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "NICHOLAS",
        "authorized_official_title_or_position": "SOLE TRUSTEE",
        "authorized_official_telephone_number": "978-683-8855",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "16194",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "16194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Andover, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2017; 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.