NPIMap

Organization Active NPI

Western Mass Periodontics PC

  • Periodontics
  • Avon, CT
National Provider Identifier
1467085407
Registry record updated Jan 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
WESTERN MASS PERIODONTICS PC
Practice address
20 W Avon Rd Ste 101
Avon, CT 06001-3677
Phone
(860) 673-0451
NPI assigned
Feb 18, 2020
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: 193200000X MULTI-SPECIALTY GROUP 1223P0300X Primary

Addresses

Primary practice location

20 W Avon Rd Ste 101
Avon, CT 06001-3677

Mailing address

65 Elm St
Worcester, MA 01609-2547

Other names 1

  • Akram E. Rafla 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

20 W Avon Rd
Ste 104
Avon, CT 06001

20 W Avon Rd
Ste 101
Avon, CT 06001
Phone (860) 673-0451

NPI Registry JSON

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

{
    "created_epoch": "1581984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642464000000",
    "number": "1467085407",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 W AVON RD STE 101",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060013677",
            "telephone_number": "860-673-0451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN MASS PERIODONTICS PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTERN MASS PERIODONTICS PC",
        "enumeration_date": "2020-02-18",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-12",
        "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Akram E. Rafla",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Avon, CT

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.