Kaitlin Elizabeth Martin Bancroft, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN1858482 Issued in MA

Practice address

38 Oxford Rd
Longmeadow, MA 01106-1530

Phone

(413) 374-4566

NPI assigned

Mar 21, 2017

Last updated

Sep 18, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dr. Kaitlin Elizabeth Martin Former name

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: kbancroft244645@direct.bostonchildrens.org

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

{
    "created_epoch": "1490054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568764800000",
    "number": "1417488651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 DRAPER RD",
            "city": "WAYLAND",
            "state": "MA",
            "postal_code": "017782131",
            "telephone_number": "413-374-4566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 OXFORD RD",
            "city": "LONGMEADOW",
            "state": "MA",
            "postal_code": "011061530",
            "telephone_number": "413-374-4566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANCROFT",
        "first_name": "KAITLIN",
        "middle_name": "ELIZABETH MARTIN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-21",
        "last_updated": "2019-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "S42646050",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MA",
            "license": "DN1858482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00000",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Pediatricdentisrycm.com",
            "affiliation": "N",
            "address_1": "63 Draper Rd",
            "city": "Wayland",
            "state": "MA",
            "country_code": "US",
            "postal_code": "017782131",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Pediatricdentistrycm.com",
            "affiliation": "N",
            "address_1": "63 Draper Rd",
            "city": "Wayland",
            "state": "MA",
            "country_code": "US",
            "postal_code": "017782131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KAITLIN",
            "last_name": "MARTIN",
            "middle_name": "ELIZABETH",
            "prefix": "DR.",
            "credential": "DMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joanne Stowell Audyatis, LMHC
• Jacqueline Baez, M.D.
• Nicole Bagge
• Christina Alves Bahgat, PA
• Nicole Baker, LMHC
• Clara Bang
• Scott M Barnett, MD
• Brett Barry, DPT,CSCS
• Averett William Heinz Bass, LICSW
• Ysabella Batista

• Pediatric Dentistry in Longmeadow, MA
• Providers in Longmeadow, MA by specialty
• Pediatric Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2019; 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.