Avalon Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

AVALON DENTAL LLC

Practice address

160 Cambridge St Unit H
Cambridge, MA 02141-1819

Phone

(617) 374-9500

NPI assigned

Feb 20, 2019

Last updated

Feb 20, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Majed Jaradeh, DMD

Title

Owner

Phone

(617) 733-9117

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1550620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550620800000",
    "number": "1700342268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 CAMBRIDGE ST UNIT H",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021411819",
            "telephone_number": "617-374-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 CAMBRIDGE ST UNIT H",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021411819",
            "telephone_number": "617-374-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVALON DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-20",
        "last_updated": "2019-02-20",
        "status": "A",
        "authorized_official_last_name": "JARADEH",
        "authorized_official_first_name": "MAJED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-733-9117",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1093930869",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Narine Avetisyan, NP
• Keyona Denise Aviles, LMHC
• Roni Rachel Avimor Horovitz, M.O.T., OTR/L
• Nelson Kisob Aweh, MD
• Leslie Allison Axford, PT, DPT

• General Practice Dentistry in Cambridge, MA
• Providers in Cambridge, 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 Feb 20, 2019; 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.