Grace Jotika DMD PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

GRACE JOTIKA DMD PC

Practice address

0 Governors Ave Ste 1
Medford, MA 02155-3035

Phone

(781) 395-5629

NPI assigned

Jun 6, 2019

Last updated

Jun 6, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Aupaiporn Grace Jotikabhukkana, DMD

Title

Owner

Phone

(617) 304-5019

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John L. Gentuso, D.M.D.

  • General Practice Dentistry
  • Medford, MA
  • NPI 1497705909
  NPD (past)

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

{
    "created_epoch": "1559779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559779200000",
    "number": "1558920298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "0 GOVERNORS AVE STE 1",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "0 GOVERNORS AVE STE 1",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553035",
            "telephone_number": "781-395-5629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE JOTIKA DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-06",
        "last_updated": "2019-06-06",
        "status": "A",
        "authorized_official_last_name": "JOTIKABHUKKANA",
        "authorized_official_first_name": "AUPAIPORN",
        "authorized_official_middle_name": "GRACE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-304-5019",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luz Marina Gonzalez-Ang, LMHC
• Naomi Ruth Goodman, PT
• Daijjah T Gordon
• Lisa Ferreira Gormley, MS, RD, LDN, CWPM
• Lynne E Gotjen
• Brian John Grace, PMHNP-BC, MBA, RN
• Shawn Grace
• James Graham, PSY.D.
• Sara Grant, FNP
• Greater Boston Oral Surgery and Dental Implant Center PLLC (Greater Boston Oral Surgery and Dental Implant Center)

• Dentist in Medford, MA
• Providers in Medford, MA by specialty
• Dentist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2019; 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.