Active NPI
Bassel Boulos
- General Practice Dentistry
- Roxbury, MA
National Provider Identifier
1467902155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 04520
- Practice address
- 1290 Tremont St
Roxbury, MA 02120-3432 - Phone
- (617) 427-1000
- NPI assigned
- Oct 6, 2016
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 04520 | NH | Primary |
Addresses
Primary practice location
1290 Tremont St
Roxbury, MA 02120-3432
Mailing address
100 Bridge St
Pelham, NH 03076-3422
Phone (603) 931-4698
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04520 | NH | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568937600000",
"number": "1467902155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 BRIDGE ST",
"city": "PELHAM",
"state": "NH",
"postal_code": "030763422",
"telephone_number": "603-931-4698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1290 TREMONT ST",
"city": "ROXBURY",
"state": "MA",
"postal_code": "021203432",
"telephone_number": "617-427-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOULOS",
"first_name": "BASSEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-10-06",
"last_updated": "2019-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NH",
"license": "04520",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roxbury, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.