Jay Muruga Theva, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN1855979 Issued in MA

Practice address

200 Westgate Dr Ste 119
Brockton, MA 02301-1810

Phone

(508) 583-3840

NPI assigned

Jun 4, 2012

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

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

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

{
    "created_epoch": "1338768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338768000000",
    "number": "1558622753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 WESTGATE DR STE 119",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023011810",
            "telephone_number": "508-583-3840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 WESTGATE DR STE 119",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023011810",
            "telephone_number": "508-583-3840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEVA",
        "first_name": "JAY",
        "middle_name": "MURUGA",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-04",
        "last_updated": "2012-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN1855979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theraconnex LLC
• Therapie LLC
• Theresa M Smith
• Fritzlaine Thermidor
• Rachelle Alessandra Thermora, PHARM D
• Mathi Theva
• Mario Thevenin
• Thibaud Healthcare Agency LLC
• Deirdre Thibault
• Jonathan Thibault

• General Practice Dentistry in Brockton, MA
• Providers in Brockton, 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 Jun 4, 2012; 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.