Nuba Afzal Siddiqi, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN1859848 Issued in MA

Practice address

75 Spring St
West Roxbury, MA 02132-4335

Phone

(585) 831-2456

NPI assigned

Jun 13, 2023

Last updated

Jul 12, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Nas Dental LLC

  • Dental Clinic/Center
  • Boston, MA
  • NPI 1336064369
  Authorized official Same address or phone

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

{
    "created_epoch": "1686614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1598449266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 SPRING ST",
            "city": "WEST ROXBURY",
            "state": "MA",
            "postal_code": "021324335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 SPRING ST",
            "city": "WEST ROXBURY",
            "state": "MA",
            "postal_code": "021324335",
            "telephone_number": "585-831-2456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQI",
        "first_name": "NUBA",
        "middle_name": "AFZAL",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-13",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN1859848",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Mark Shea, DMD
• Richard John Shea, DMD
• Richard W Shea, DMD
• Paula Shevenell, LMHC
• Kathleen Mary Shute, NP
• Cory Daniel Siegel, M.D.
• Connor J Simpson, PT, DPT
• Deborah Ann Sisson, MS. RDN
• Lara M Skarf, M.D.
• Kelly Dolan Skinner, NP

• General Practice Dentistry in West Roxbury, MA
• Providers in West Roxbury, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; 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.

Verify at the official NPI Registry.