NPIMap

Organization Active NPI

Rafael Villacorta Family Dentistry

  • Oral and Maxillofacial Pathology Dentistry
  • Waltham, MA
National Provider Identifier
1700057346
Registry record updated Mar 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X
License
18063 Issued in MA
Legal business name
RAFAEL VILLACORTA FAMILY DENTISTRY
Practice address
24 Crescent St
Suite 303
Waltham, MA 02453-4358
Phone
(781) 891-5637
Fax
(781) 891-8925
NPI assigned
Mar 21, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2008

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

Authorized official

Name
Dr. Rafael E Villacorta, DMDNPI 1952471708
Title
President
Phone
(781) 891-5637

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Pathology DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0106X 18063 MA Primary

Addresses

Primary practice location

24 Crescent St
Suite 303
Waltham, MA 02453-4358

Mailing address

24 Crescent St
Suite 303
Waltham, MA 02453-4358
Phone (781) 891-5637

Other identifiers 2

IdentifierTypeStateIssuer
0274771MedicaidMA
9708049MedicaidMA

National Provider Directory

National Provider Directory

Locations

24 Crescent St
Ste 303
Waltham, MA 02453
Phone (781) 891-5637

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1206057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206057600000",
    "number": "1700057346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 CRESCENT ST",
            "address_2": "SUITE 303",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024534358",
            "telephone_number": "781-891-5637",
            "fax_number": "781-891-8925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 CRESCENT ST",
            "address_2": "SUITE 303",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024534358",
            "telephone_number": "781-891-5637",
            "fax_number": "781-891-8925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAFAEL VILLACORTA FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-21",
        "last_updated": "2008-03-21",
        "status": "A",
        "authorized_official_last_name": "VILLACORTA",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-891-5637",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "MA",
            "license": "18063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0274771",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9708049",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waltham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 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.

Verify at the official NPI Registry.