NPIMap

Organization Active NPI

Webster Square Dental

  • General Practice Dentistry
  • Worcester, MA
National Provider Identifier
1629116355
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
19810 Issued in MA
Legal business name
WEBSTER SQUARE DENTAL
Practice address
17 Young St
Worcester, MA 01603-1420
Phone
(508) 753-6777
Fax
(508) 753-0206
NPI assigned
Feb 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Kenny Lam, DMDNPI 1831210632
Title
Owner
Phone
(508) 753-6777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 19810 MA Primary

Addresses

Primary practice location

17 Young St
Worcester, MA 01603-1420

Mailing address

17 Young St
Worcester, MA 01603-1420
Phone (508) 753-6777

Other identifiers 4

IdentifierTypeStateIssuer
9712470MedicaidMA
0202991MedicaidMA
0208281MedicaidMA
0282073MedicaidMA

National Provider Directory

National Provider Directory

Locations

17 Young St
Worcester, MA 01603
Phone (508) 753-6777

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629116355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 YOUNG ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016031420",
            "telephone_number": "508-753-6777",
            "fax_number": "508-753-0206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 YOUNG ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016031420",
            "telephone_number": "508-753-6777",
            "fax_number": "508-753-0206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEBSTER SQUARE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LAM",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-753-6777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "19810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9712470",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0202991",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0208281",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0282073",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.