Nimit Bajaj, DMD
Individual provider Active NPI General Practice Dentistry · Medford, MA
NPI 1639891773 · NPPES record last updated Mar 2, 2025
Key facts
- NPI
- 1639891773
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DN1859617 (MA)
- Practice address
- 23 Riverside Ave
Medford, MA 02155-4605 - Phone
- (617) 430-6840
- NPI assigned
- Sep 15, 2022
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221129001748 | MA | Order and Referring Only - Dentist |
1254709033 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1859617 | MA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN1859617 | MA | Yes |
Addresses
Primary practice location
23 Riverside Ave
Medford, MA 02155-4605
Mailing address
485 Foley St
Somerville, MA 02145-1266
Phone (832) 708-5812
Other providers in Medford, MA
- Atrius Health, Inc.
- Bhawna Awal
- Lily Alice Ayotte
- Alicia M Azpiri Magallanes
- Kerri Ann Babish
- Laurie Ann Baker
- Michele Baker
- Susan Baker
- Margaret Balya
- David Banks
All providers in Medford, MA · General Practice Dentistry in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 2, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.