Active NPI
Kenneth L. Zachmann, D.D.S.
- General Practice Dentistry
- Wayland, MA
National Provider Identifier
1578720405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 17774
- Practice address
- 52 Cochituate Rd
Wayland, MA 01778-2607 - Phone
- (508) 358-2091
- NPI assigned
- May 19, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 17774 | MA | Primary |
Addresses
Primary practice location
52 Cochituate Rd
Wayland, MA 01778-2607
Mailing address
52 Cochituate Rd
Wayland, MA 01778-2607
Phone (508) 358-2091
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Y52842 | Other | MA | BLUE CROSS AND BLUE SHIELD |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160611000012 | MA | Order and Referring Only - Other (Physician) | 8628368156 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17774 | MA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211155200000",
"number": "1578720405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "52 COCHITUATE RD",
"city": "WAYLAND",
"state": "MA",
"postal_code": "017782607",
"telephone_number": "508-358-2091"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "52 COCHITUATE RD",
"city": "WAYLAND",
"state": "MA",
"postal_code": "017782607",
"telephone_number": "508-358-2091"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZACHMANN",
"first_name": "KENNETH",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-19",
"last_updated": "2008-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "17774",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS AND BLUE SHIELD",
"identifier": "Y52842",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wayland, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; 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.