NPIMap

Organization Active NPI

Venusdentalpc

  • Preferred Provider Organization
  • Maynard, MA
National Provider Identifier
1619351269
Registry record updated Jul 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
DN1856317 Issued in MA
Legal business name
VENUSDENTALPC
Practice address
63 Great Rd Ste 105
Maynard, MA 01754-2097
Phone
(978) 298-5281
NPI assigned
Jul 14, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2015

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

Authorized official

Name
Azadeh Shahab
Title
Dentistowner
Phone
(978) 298-5281

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X DN1856317 MA Primary

Addresses

Primary practice location

63 Great Rd Ste 105
Maynard, MA 01754-2097

Mailing address

63 Great Rd Ste 105
Maynard, MA 01754-2097
Phone (978) 298-5281

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1436832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436832000000",
    "number": "1619351269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 GREAT RD STE 105",
            "city": "MAYNARD",
            "state": "MA",
            "postal_code": "017542097",
            "telephone_number": "978-298-5281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 GREAT RD STE 105",
            "city": "MAYNARD",
            "state": "MA",
            "postal_code": "017542097",
            "telephone_number": "978-298-5281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VENUSDENTALPC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-14",
        "last_updated": "2015-07-14",
        "status": "A",
        "authorized_official_last_name": "SHAHAB",
        "authorized_official_first_name": "AZADEH",
        "authorized_official_title_or_position": "DENTISTOWNER",
        "authorized_official_telephone_number": "978-298-5281"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "MA",
            "license": "DN1856317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maynard, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2015; 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.