Active NPI
Raymond Widican, DDS
- Pediatric Dentistry
- Braintree, MA
National Provider Identifier
1629047139
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 9962
- Practice address
- 111 Grossman Dr
Braintree, MA 02184-4997 - Phone
- (781) 849-2255
- NPI assigned
- Mar 16, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 9962 | MA | Primary |
Addresses
Primary practice location
111 Grossman Dr
Braintree, MA 02184-4997
Mailing address
147 Milk St
Provider Enrollment 9TH Floor
Boston, MA 02109-4806
Phone (617) 559-8051
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PH152 | Other | MA | HARVARD PILGRIM |
| X03621 | Other | MA | BCBS - DENTAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9962 | MA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239148800000",
"number": "1629047139",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "147 MILK ST",
"address_2": "PROVIDER ENROLLMENT 9TH FLOOR",
"city": "BOSTON",
"state": "MA",
"postal_code": "021094806",
"telephone_number": "617-559-8051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 GROSSMAN DR",
"city": "BRAINTREE",
"state": "MA",
"postal_code": "021844997",
"telephone_number": "781-849-2255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIDICAN",
"first_name": "RAYMOND",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-16",
"last_updated": "2009-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MA",
"license": "9962",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "PH152",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS - DENTAL",
"identifier": "X03621",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Braintree, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.