Active NPI
Jorge Emilio Peralta Gonzalez, DMD
- Dentist
- Roxbury, MA
National Provider Identifier
1649021296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN10000576
- Practice address
- 16 Taber St Unit 304
Roxbury, MA 02119-4231 - Phone
- (914) 572-1195
- NPI assigned
- Apr 1, 2024
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | DN10000576 | MA | Primary |
Addresses
Primary practice location
16 Taber St Unit 304
Roxbury, MA 02119-4231
Mailing address
19 Kenilworth St Apt 3
Roxbury, MA 02119-1877
Phone (914) 572-1195
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 |
|---|---|---|---|
| DN10000576 | MA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740441600000",
"number": "1649021296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 KENILWORTH ST APT 3",
"city": "ROXBURY",
"state": "MA",
"postal_code": "021191877",
"telephone_number": "914-572-1195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16 TABER ST UNIT 304",
"city": "ROXBURY",
"state": "MA",
"postal_code": "021194231",
"telephone_number": "914-572-1195"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERALTA GONZALEZ",
"first_name": "JORGE",
"middle_name": "EMILIO",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-04-01",
"last_updated": "2025-02-25",
"certification_date": "2025-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DN10000576",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roxbury, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.