NPIMap

Organization Active NPI

Kevin P Mooney DDS PC

  • General Practice Dentistry
  • Woburn, MA
National Provider Identifier
1578613865
Registry record updated Sep 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
16749 Issued in MA
Legal business name
KEVIN P MOONEY DDS PC
Practice address
3 Baldwin Green CMN
Suite 101
Woburn, MA 01801-1865
Phone
(781) 932-5999
Fax
(781) 935-4804
NPI assigned
Jan 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2007

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

Authorized official

Name
Dr. Kevin P Mooney, DDSNPI 1750431177
Title
President
Phone
(781) 932-5999

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 16749 MA Primary

Addresses

Primary practice location

3 Baldwin Green CMN
Suite 101
Woburn, MA 01801-1865

Mailing address

3 Baldwin Green CMN
Suite 101
Woburn, MA 01801-1865
Phone (781) 932-5999

Other identifiers 2

IdentifierTypeStateIssuer
X11819OtherMABLUE CROSS BLUE SHIELD
709783OtherMAUNITED CONCORDIA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190073600000",
    "number": "1578613865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 BALDWIN GREEN CMN",
            "address_2": "SUITE 101",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011865",
            "telephone_number": "781-932-5999",
            "fax_number": "781-935-4804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 BALDWIN GREEN CMN",
            "address_2": "SUITE 101",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011865",
            "telephone_number": "781-932-5999",
            "fax_number": "781-935-4804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN P MOONEY DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2007-09-18",
        "status": "A",
        "authorized_official_last_name": "MOONEY",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-932-5999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "16749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "X11819",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "709783",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woburn, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2007; 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.