NPIMap

Organization Active NPI

Western Mass Periodontics PC

  • Periodontics
  • Agawam, MA
National Provider Identifier
1457709180
Registry record updated Jan 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
19671 Issued in MA
Legal business name
WESTERN MASS PERIODONTICS PC
Practice address
158 Main St
Agawam, MA 01001
Phone
(413) 786-2341
NPI assigned
Jun 3, 2016
Organization subpart
Yes
Parent organization
WESTERN MASS PERIODONTICS PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 18, 2022

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

Authorized official

Name
Leah Ann Maylott
Title
Credentialing Administrator
Phone
(860) 874-8198

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0300X 19671 MA Primary

Addresses

Primary practice location

158 Main St
Agawam, MA 01001

Mailing address

65 Elm St
Worcester, MA 01609-2547
Phone (860) 874-8198

Other names 1

  • Nobel Perio Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Western Mass Periodontics PC4 organizations share this tax ID, including this one
Part of
Western Mass Periodontics PC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

158 Main St
Agawam, MA 01001
Phone (413) 786-2341

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

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": "1464912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642464000000",
    "number": "1457709180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 ELM ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016092547",
            "telephone_number": "860-874-8198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 MAIN ST",
            "city": "AGAWAM",
            "state": "MA",
            "postal_code": "01001",
            "telephone_number": "413-786-2341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN MASS PERIODONTICS PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTERN MASS PERIODONTICS PC",
        "enumeration_date": "2016-06-03",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-11",
        "status": "A",
        "authorized_official_last_name": "MAYLOTT",
        "authorized_official_first_name": "LEAH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CREDENTIALING ADMINISTRATOR",
        "authorized_official_telephone_number": "860-874-8198"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MA",
            "license": "19671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nobel Perio",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Nobel Perio",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Agawam, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2022; 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.