Individual provider Active NPI

Kinan Kanbar, D.M.D

  • General Practice Dentistry
  • Acton, MA
National Provider Identifier
1487738340
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
19336 Issued in MA
Practice address
296 Great Rd
Acton, MA 01720-4710
Phone
(978) 263-8525
Fax
(978) 263-2955
NPI assigned
Oct 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 19336 MA Primary

Addresses

Primary practice location

296 Great Rd
Acton, MA 01720-4710

Mailing address

296 Great Rd
Acton, MA 01720-4710
Phone (978) 263-8525

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160525001480 MA Order and Referring Only - DentistPractitioner - Dentist 7911296371

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
19336MAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487738340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "296 GREAT RD",
            "city": "ACTON",
            "state": "MA",
            "postal_code": "017204710",
            "telephone_number": "978-263-8525",
            "fax_number": "978-263-2955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "296 GREAT RD",
            "city": "ACTON",
            "state": "MA",
            "postal_code": "017204710",
            "telephone_number": "978-263-8525",
            "fax_number": "978-263-2955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANBAR",
        "first_name": "KINAN",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "19336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Acton, MA

Sources for this page

Verify at the official NPI Registry.