Individual provider Active NPI

Fidelito Gabriel, DMD

  • General Practice Dentistry
  • Boston, MA
National Provider Identifier
1619919909
Registry record updated Oct 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
21464 Issued in MA
Practice address
1815 Dorchester Ave
Boston, MA 02124-2551
Phone
(617) 763-9351
NPI assigned
Jun 12, 2006
Last updated
Oct 23, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 21464 MA Primary

Addresses

Primary practice location

1815 Dorchester Ave
Boston, MA 02124-2551

Mailing address

1815 Dorchester Ave
Boston, MA 02124-2551
Phone (617) 763-9351

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160201001490 MA Practitioner - Oral Surgery 0345544078 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
21464MAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Brockton Neighborhood Health Center CurrentSince Oct 11, 2015 Accepting new patients
Brockton Neighborhood Health Center, Inc. CurrentSince Oct 11, 2015 Accepting new patients
Brockton Neighborhood Health Center Past Accepting new patients

Locations

158 Pleasant St
Brockton, MA 02301
Phone (508) 894-3363

63 Main St
Brockton, MA 02301
Phone (508) 559-6696

Interoperability endpoints

  • Direct secure messaging: fgabriel19345@direct.ctc.masshiway.net
  • FHIR API: https://epicproxy.et1290.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792713600000",
    "number": "1619919909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 DORCHESTER AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021242551",
            "telephone_number": "617-763-9351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 DORCHESTER AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021242551",
            "telephone_number": "617-763-9351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GABRIEL",
        "first_name": "FIDELITO",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2026-10-23",
        "certification_date": "2026-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "21464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.