Active NPI
Ryan Lisann
- Dentist
- Somerville, MA
National Provider Identifier
1427668029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN1858741
- Practice address
- 474 Broadway Apt 110
Somerville, MA 02145-2630 - Phone
- (617) 623-2223
- NPI assigned
- Aug 7, 2020
- Last updated
- Aug 7, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN1858741 | MA | Primary |
Addresses
Primary practice location
474 Broadway Apt 110
Somerville, MA 02145-2630
Mailing address
73 River St Apt 2B
Cambridge, MA 02139-3818
Phone (631) 896-3506
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1858741 | MA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596758400000",
"number": "1427668029",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "73 RIVER ST APT 2B",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021393818",
"telephone_number": "631-896-3506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "474 BROADWAY APT 110",
"city": "SOMERVILLE",
"state": "MA",
"postal_code": "021452630",
"telephone_number": "617-623-2223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LISANN",
"first_name": "RYAN",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-08-07",
"last_updated": "2020-08-07",
"certification_date": "2020-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DN1858741",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Somerville, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.