NPIMap

Organization Active NPI

Arena Dental LLC

  • Dentist
  • Worcester, MA
National Provider Identifier
1487892683
Registry record updated Jan 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
ARENA DENTAL LLC
Practice address
1049 Main St
Worcester, MA 01603-2485
Phone
(617) 633-7121
NPI assigned
Jan 26, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2009

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

Authorized official

Name
Dr. Andrey Mazo, DMD
Title
President
Phone
(508) 870-1911

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

1049 Main St
Worcester, MA 01603-2485

Mailing address

1049 Main St
Worcester, MA 01603-2485
Phone (617) 633-7121

Other identifiers 1

IdentifierTypeStateIssuer
0277975MedicaidMA

National Provider Directory

National Provider Directory

Locations

1049 Main St
Worcester, MA 01603
Phone (617) 633-7121

NPI Registry JSON

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

{
    "created_epoch": "1232928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232928000000",
    "number": "1487892683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1049 MAIN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016032485",
            "telephone_number": "617-633-7121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1049 MAIN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016032485",
            "telephone_number": "617-633-7121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARENA DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-26",
        "last_updated": "2009-01-26",
        "status": "A",
        "authorized_official_last_name": "MAZO",
        "authorized_official_first_name": "ANDREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "508-870-1911",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0277975",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2009; 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.