Active NPI
Gary C Demetriou, D.M.D.
- General Practice Dentistry
- North Andover, MA
National Provider Identifier
1508946534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 16603
- Practice address
- 198 Massachusetts Ave
Suite 202
North Andover, MA 01845-4143 - Phone
- (978) 794-0010
- Fax
- (978) 683-3790
- NPI assigned
- Oct 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | 16603 | MA | Primary |
Addresses
Primary practice location
198 Massachusetts Ave
Suite 202
North Andover, MA 01845-4143
Mailing address
198 Massachusetts Ave
Suite 202
North Andover, MA 01845-4143
Phone (978) 794-0010
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 16603 | Other | MA | LICENSE NUMBER |
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 |
|---|---|---|---|
| 16603 | MA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508946534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "198 MASSACHUSETTS AVE",
"address_2": "SUITE 202",
"city": "NORTH ANDOVER",
"state": "MA",
"postal_code": "018454143",
"telephone_number": "978-794-0010",
"fax_number": "978-683-3790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "198 MASSACHUSETTS AVE",
"address_2": "SUITE 202",
"city": "NORTH ANDOVER",
"state": "MA",
"postal_code": "018454143",
"telephone_number": "978-794-0010",
"fax_number": "978-683-3790"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMETRIOU",
"first_name": "GARY",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "16603",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "16603",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Andover, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.