NPIMap

Organization Active NPI

Cambridge Pediatric Dental Associates, P.C.

  • Pediatric Dentistry
  • Cambridge, MA
National Provider Identifier
1710030986
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
10343 Issued in MA
Legal business name
CAMBRIDGE PEDIATRIC DENTAL ASSOCIATES, P.C.
Practice address
1749 Massachusetts Ave
Cambridge, MA 02140-2217
Phone
(617) 491-1161
NPI assigned
Jan 19, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. George Wellington McEachern III, D.M.D.NPI 1265583348
Title
President
Phone
(617) 491-1161

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 10343 MA Primary

Addresses

Primary practice location

1749 Massachusetts Ave
Cambridge, MA 02140-2217

Mailing address

1749 Massachusetts Ave
Cambridge, MA 02140-2217
Phone (617) 491-1161

Other identifiers 1

IdentifierTypeStateIssuer
9732985MedicaidMA

Other names 1

  • George W. McEachern III, DMD, PC Former legal business name

National Provider Directory

National Provider Directory

Locations

1749 Massachusetts Ave
Cambridge, MA 02140
Phone (617) 491-1161

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710030986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1749 MASSACHUSETTS AVE",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021402217",
            "telephone_number": "617-491-1161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1749 MASSACHUSETTS AVE",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021402217",
            "telephone_number": "617-491-1161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMBRIDGE PEDIATRIC DENTAL ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCEACHERN",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "WELLINGTON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-491-1161",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MA",
            "license": "10343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9732985",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "George W. McEachern III, DMD, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Cambridge, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.