Carolina Perdomo Ruiz, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DL12910 Issued in MA

Practice address

55 Dimock St
Roxbury, MA 02119-1029

Phone

(617) 442-8800

Fax

(617) 442-4088

NPI assigned

Jun 16, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467158400000",
    "number": "1669822078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 DIMOCK ST",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021191029",
            "telephone_number": "617-442-8800",
            "fax_number": "617-442-4088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 DIMOCK ST",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021191029",
            "telephone_number": "617-442-8800",
            "fax_number": "617-442-4088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERDOMO RUIZ",
        "first_name": "CAROLINA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-16",
        "last_updated": "2016-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DL12910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenny Jandiel Pena
• Melissa Pena
• Sean Penchinar
• Jamie Pepin
• Jorge Emilio Peralta Gonzalez, DMD
• Elen Perez Clementino
• Ayana Marie Perez, MA
• Milagros Perez
• Tory Perry-Tsaku
• Adell Denise Perry

• General Practice Dentistry in Roxbury, MA
• Providers in Roxbury, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.