NPIMap

Organization Active NPI

Wahid Mistikawi Dba Greatwoods Family Dentistry

  • Preferred Provider Organization
  • Mansfield, MA
National Provider Identifier
1417399270
Registry record updated Jul 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
DN17639 Issued in MA
Legal business name
WAHID MISTIKAWI DBA GREATWOODS FAMILY DENTISTRY
Practice address
792South Main St
24
Mansfield, MA 02048-3137
Phone
(508) 339-4171
Fax
(508) 339-8311
NPI assigned
Jul 22, 2013
Last updated
Jul 22, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2013

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

Authorized official

Name
Dr. Wahid Mistikawi, D.M.DNPI 1710135033
Title
Dentist
Phone
(508) 339-4171

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X DN17639 MA Primary

Addresses

Primary practice location

792South Main St
24
Mansfield, MA 02048-3137

Mailing address

792 S Main St
Mansfield, MA 02048-3137
Phone (508) 339-4171

National Provider Directory

National Provider Directory
Tax ID family
Great Woods Family Dentistry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

792 S Main St
Mansfield, MA 02048
Phone (774) 331-8224

792 S Main St
#24
Mansfield, MA 02048
Phone (508) 339-4171

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": "1374451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374451200000",
    "number": "1417399270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "792 S MAIN ST",
            "city": "MANSFIELD",
            "state": "MA",
            "postal_code": "020483137",
            "telephone_number": "508-339-4171",
            "fax_number": "508-339-8311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "792SOUTH MAIN ST",
            "address_2": "24",
            "city": "MANSFIELD",
            "state": "MA",
            "postal_code": "020483137",
            "telephone_number": "508-339-4171",
            "fax_number": "508-339-8311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAHID MISTIKAWI DBA GREATWOODS FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-22",
        "last_updated": "2013-07-22",
        "status": "A",
        "authorized_official_last_name": "MISTIKAWI",
        "authorized_official_first_name": "WAHID",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "508-339-4171",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "MA",
            "license": "DN17639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mansfield, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2013; 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.