Active NPI
David Pelham, DDS,MMSC
- Periodontics
- Braintree, MA
National Provider Identifier
1437189388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 20167
- Practice address
- 300 Granite St
South Shore Dental Group
Braintree, MA 02184-3909 - Phone
- (781) 843-7800
- NPI assigned
- Jul 4, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 20167 | MA | Primary |
Addresses
Primary practice location
300 Granite St
South Shore Dental Group
Braintree, MA 02184-3909
Mailing address
14 Overlook Dr
Southborough, MA 01772-1218
Phone (617) 281-5838
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150522000124 | MA | Order and Referring Only - Oral Surgery | 4880914498 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20167 | MA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1437189388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 OVERLOOK DR",
"city": "SOUTHBOROUGH",
"state": "MA",
"postal_code": "017721218",
"telephone_number": "617-281-5838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 GRANITE ST",
"address_2": "SOUTH SHORE DENTAL GROUP",
"city": "BRAINTREE",
"state": "MA",
"postal_code": "021843909",
"telephone_number": "781-843-7800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELHAM",
"first_name": "DAVID",
"credential": "DDS,MMSC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MA",
"license": "20167",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Braintree, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.