Active NPI
Mansour Moheban, D.M.D.
- Periodontics
- Northborough, MA
National Provider Identifier
1679632467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 11905
- Practice address
- 154 Main St
Northborough, MA 01532-1930 - Phone
- (508) 393-2522
- Fax
- (508) 393-9782
- NPI assigned
- Dec 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 11905 | MA | Primary |
Addresses
Primary practice location
154 Main St
Northborough, MA 01532-1930
Mailing address
154 Main St
Northborough, MA 01532-1930
Phone (508) 393-2522
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 |
|---|---|---|---|
| 11905 | MA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| M Moheban DMD PC | Past | Accepting new patients | |
| Northborough Family Dental, PC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Northborough, MA
- NPI 1326207796
-
- Dental Clinic/Center
- Northborough, MA
- NPI 1760870497
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203897600000",
"number": "1679632467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "154 MAIN ST",
"city": "NORTHBOROUGH",
"state": "MA",
"postal_code": "015321930",
"telephone_number": "508-393-2522",
"fax_number": "508-393-9782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "154 MAIN ST",
"city": "NORTHBOROUGH",
"state": "MA",
"postal_code": "015321930",
"telephone_number": "508-393-2522",
"fax_number": "508-393-9782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOHEBAN",
"first_name": "MANSOUR",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-07",
"last_updated": "2008-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MA",
"license": "11905",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northborough, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.