My Dental Warren St

Primary specialty

DentistTaxonomy code 122300000X

License

DN22184 Issued in MA

Legal business name

MY DENTAL WARREN ST

Practice address

376 Warren St
Roxbury, MA 02119-1830

Phone

(740) 215-8549

NPI assigned

Mar 16, 2018

Organization subpart

No

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

Authorized official

Name

Srinivas Desaneedi, DMD

Title

Dentist

Phone

(740) 215-8549

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1521158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521158400000",
    "number": "1578066312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 BALANCING ROCK RD",
            "city": "CANTON",
            "state": "MA",
            "postal_code": "020214230",
            "telephone_number": "740-215-8549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "376 WARREN ST",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021191830",
            "telephone_number": "740-215-8549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY DENTAL WARREN ST",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-16",
        "last_updated": "2018-03-16",
        "status": "A",
        "authorized_official_last_name": "DESANEEDI",
        "authorized_official_first_name": "SRINIVAS",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "740-215-8549",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN22184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yejide Muhammad, M.ED
• Maddison A Mulvey
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• Jamilah R Murrell
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• Dentist in Roxbury, MA
• Providers in Roxbury, MA by specialty
• Dentist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2018; 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.