Individual provider Active NPI

Stephen Waxman, D.M.D.

  • Dentist
  • Worcester, MA
National Provider Identifier
1528271319
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
11549 Issued in MA
Practice address
255 Park Ave
Suite 904
Worcester, MA 01609-1953
Phone
(508) 792-9010
NPI assigned
May 8, 2007
Last updated
Jul 8, 2007By the provider in NPPES
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
Dentist 122300000X 11549 MA Primary

Addresses

Primary practice location

255 Park Ave
Suite 904
Worcester, MA 01609-1953

Mailing address

8 Saxon Rd
Worcester, MA 01602-1522
Phone (508) 615-7200

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
I20150309001836 MA Order and Referring Only - DentistPractitioner - Dentist 2860718970

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11549MAMDClinical Psychologist

Organizations & group practices 2

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

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": "1183852800000",
    "number": "1528271319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 SAXON RD",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016021522",
            "telephone_number": "508-615-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 PARK AVE",
            "address_2": "SUITE 904",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016091953",
            "telephone_number": "508-792-9010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAXMAN",
        "first_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "11549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.