Brockton Oral & Maxillofacial Surgery Inc

Primary specialty

DentistTaxonomy code 122300000X

License

16545 Issued in MA

Legal business name

BROCKTON ORAL & MAXILLOFACIAL SURGERY INC

Practice address

1351 Main St
Brockton, MA 02301

Phone

(508) 587-2000

Fax

(508) 580-3552

NPI assigned

Jul 19, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Paul M Fitzgerald, DMDNPI 1275588956

Title

President

Phone

(508) 587-2000

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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.

• Paul Martin Fitzgerald, DMD

  • Dentist
  • Brockton, MA
  • NPI 1275588956
  Authorized official Same address or phone

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457370504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1351 MAIN ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "02301",
            "telephone_number": "508-587-2000",
            "fax_number": "508-580-3552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1351 MAIN ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "02301",
            "telephone_number": "508-587-2000",
            "fax_number": "508-580-3552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROCKTON ORAL & MAXILLOFACIAL SURGERY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FITZGERALD",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "508-587-2000",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "16545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "X10443",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9774521",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brockton Neighborhood Health Center
• Brockton Neighborhood Health Center
• Brockton Neighborhood Health Center
• Brockton Neighborhood Health Center, Inc. (BNHC Pharmacy)
• Brockton Operator LLC (Brockton Post Acute Care)
• Brockton Pediatrics
• Brockton Pharmacy, LLC (Brockton Pharmacy)
• Brockton Physical Therapy & Rehabilitation, Inc.
• Brockton Radiation Oncology
• Brockton Radiological Associates, Inc.

• Dentist in Brockton, MA
• Providers in Brockton, MA by specialty
• Dentist in Massachusetts

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

Verify at the official NPI Registry.