Christos Koumoutseas

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

17622 Issued in MA

Practice address

1417Dorchester Ave
Boston, MA 02122

Phone

(617) 929-4300

NPI assigned

Mar 30, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Christos Koumoutseas Professional name

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Metropolitan Dental Center

  • General Practice Dentistry
  • Dorchester, MA
  • NPI 1154564490
  NPD (past) Authorized official

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1487774634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1417 DORCHESTER AVE",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021222915",
            "telephone_number": "617-929-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417DORCHESTER AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02122",
            "telephone_number": "617-929-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUMOUTSEAS",
        "first_name": "CHRISTOS",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-30",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "17622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2177598",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTOS",
            "last_name": "KOUMOUTSEAS",
            "prefix": "DR.",
            "credential": "D.M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Julie Kotzen, LICSW
• Bakey Kouanda
• Rashmi Koul
• Michail Koulianos, D.D.S.
• Kendra Kouloheras, MS, FNP-BC, RN
• Dylan Charles Koundakjian, MD
• Lauren Marie Koup, PA-C
• Stella Kourembanas, MD
• Arianne Kourosh, MD
• Marie S Kourtelidis, CNM

• General Practice Dentistry in Boston, MA
• Providers in Boston, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.