Active NPI
Peach B Dore-Tyrell, DMD
- General Practice Dentistry
- Dorchester, MA
National Provider Identifier
1497968952
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 19161
- Practice address
- 172 Ashmont St.
Dorchester, MA 02124 - Phone
- (617) 288-2920
- Fax
- (617) 288-2992
- NPI assigned
- May 8, 2007
- Sex
- Female
- 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 | 19161 | MA | Primary |
Addresses
Primary practice location
172 Ashmont St.
Dorchester, MA 02124
Mailing address
720 Canton Ave
Milton, MA 02186
Phone (617) 298-7165
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 |
|---|---|---|---|
| 19161 | MA | MD | General Practice Dentistry |
Interoperability endpoints
- pdoretyrell244682@direct.bostonchildrens.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218412800000",
"number": "1497968952",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "720 CANTON AVE",
"city": "MILTON",
"state": "MA",
"postal_code": "02186",
"telephone_number": "617-298-7165",
"fax_number": "617-288-2992"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "172 ASHMONT ST.",
"city": "DORCHESTER",
"state": "MA",
"postal_code": "02124",
"telephone_number": "617-288-2920",
"fax_number": "617-288-2992"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DORE-TYRELL",
"first_name": "PEACH",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-08",
"last_updated": "2008-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "19161",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dorchester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.