NPIMap

Organization Active NPI

Boutselis Family Dental Care PC

  • General Practice Dentistry
  • Tewksbury, MA
National Provider Identifier
1457423154
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
11196 Issued in MA
Legal business name
BOUTSELIS FAMILY DENTAL CARE PC
Practice address
381R Main Street
Tewksbury, MA 01876
Phone
(978) 640-1114
Fax
(978) 640-1117
NPI assigned
Nov 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. George Alexander Boutselis, DMD
Title
Owner President
Phone
(978) 640-1114

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 11196 MA Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 18573 MA

Addresses

Primary practice location

381R Main Street
Tewksbury, MA 01876

Mailing address

381R Main Street
Tewksbury, MA 01876
Phone (978) 640-1114

National Provider Directory

National Provider Directory

Locations

381R Main St
Tewksbury, MA 01876
Phone (978) 640-1114

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457423154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "381R MAIN STREET",
            "city": "TEWKSBURY",
            "state": "MA",
            "postal_code": "01876",
            "telephone_number": "978-640-1114",
            "fax_number": "978-640-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "381R MAIN STREET",
            "city": "TEWKSBURY",
            "state": "MA",
            "postal_code": "01876",
            "telephone_number": "978-640-1114",
            "fax_number": "978-640-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUTSELIS FAMILY DENTAL CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOUTSELIS",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "978-640-1114",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "11196",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "18573",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tewksbury, MA

Sources for this page

  • 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.