NPIMap

Organization Active NPI

Melrose Wakefield Oral Surgery Inc.

  • Oral and Maxillofacial Surgery (Dentist)
  • Melrose, MA
National Provider Identifier
1568409902
Registry record updated Apr 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
MELROSE WAKEFIELD ORAL SURGERY INC.
Practice address
810 Main St
Melrose, MA 02176-2711
Phone
(781) 662-6228
Fax
(781) 662-4455
NPI assigned
Jun 2, 2006
Last updated
Apr 1, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2015

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

Authorized official

Name
Janet Nightingale
Title
Manager
Phone
(781) 662-6228

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X Primary

Addresses

Primary practice location

810 Main St
Melrose, MA 02176-2711

Mailing address

810 Main St
Melrose, MA 02176-2711
Phone (781) 662-6228

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060419000533 MA Part B Supplier - Clinic/Group Practice 0244249209 Receives reassigned benefits from 6 practitioners
Practice locations: Melrose, MA

National Provider Directory

National Provider Directory

Locations

810 Main St
Melrose, MA 02176
Phone (781) 662-6228

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427846400000",
    "number": "1568409902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 MAIN ST",
            "city": "MELROSE",
            "state": "MA",
            "postal_code": "021762711",
            "telephone_number": "781-662-6228",
            "fax_number": "781-662-4455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 MAIN ST",
            "city": "MELROSE",
            "state": "MA",
            "postal_code": "021762711",
            "telephone_number": "781-662-6228",
            "fax_number": "781-662-4455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELROSE WAKEFIELD ORAL SURGERY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2015-04-01",
        "status": "A",
        "authorized_official_last_name": "NIGHTINGALE",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "781-662-6228"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melrose, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.