NPIMap

Organization Active NPI

Davis Square Dental Group

  • General Practice Dentistry
  • Somerville, MA
National Provider Identifier
1629341540
Registry record updated Feb 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DAVIS SQUARE DENTAL GROUP
Practice address
30 College Ave
Suite 300
Somerville, MA 02144-1914
Phone
(617) 764-2247
NPI assigned
Feb 23, 2012
Last updated
Feb 23, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2012

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

Authorized official

Name
Dr. Mouhab RizkallahNPI 1629095450
Title
President
Phone
(617) 872-4499

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

30 College Ave
Suite 300
Somerville, MA 02144-1914

Mailing address

30 College Ave
Somerville, MA 02144-1914

National Provider Directory

National Provider Directory
Tax ID family
Davis Square Dental Group6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

30 College Ave
Ste 300
Somerville, MA 02144
Phone (617) 764-2247

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1329955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329955200000",
    "number": "1629341540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 COLLEGE AVE",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021441914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 COLLEGE AVE",
            "address_2": "SUITE 300",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021441914",
            "telephone_number": "617-764-2247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVIS SQUARE DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-23",
        "last_updated": "2012-02-23",
        "status": "A",
        "authorized_official_last_name": "RIZKALLAH",
        "authorized_official_first_name": "MOUHAB",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-872-4499",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Somerville, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2012; 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.