NPIMap

Organization Active NPI

Conant Street Dental LLC

  • General Practice Dentistry
  • Danvers, MA
National Provider Identifier
1710382676
Registry record updated Nov 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN22272 Issued in MA
Legal business name
CONANT STREET DENTAL LLC
Practice address
36 Conant St Ste 4
Danvers, MA 01923-2954
Phone
(978) 774-3331
Fax
(978) 774-3331
NPI assigned
Nov 4, 2014
Last updated
Nov 4, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2014

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

Authorized official

Name
Dr. Seunghee Song
Title
Dentist
Phone
(978) 774-3331

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN22272 MA Primary

Addresses

Primary practice location

36 Conant St Ste 4
Danvers, MA 01923-2954

Mailing address

36 Conant St Ste 4
Danvers, MA 01923-2954
Phone (978) 774-3331

Other identifiers 1

IdentifierTypeStateIssuer
1871741983OtherMANPI

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1415059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415059200000",
    "number": "1710382676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 CONANT ST STE 4",
            "city": "DANVERS",
            "state": "MA",
            "postal_code": "019232954",
            "telephone_number": "978-774-3331",
            "fax_number": "978-774-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 CONANT ST STE 4",
            "city": "DANVERS",
            "state": "MA",
            "postal_code": "019232954",
            "telephone_number": "978-774-3331",
            "fax_number": "978-774-3331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONANT STREET DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-04",
        "last_updated": "2014-11-04",
        "status": "A",
        "authorized_official_last_name": "SONG",
        "authorized_official_first_name": "SEUNGHEE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "978-774-3331",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN22272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1871741983",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danvers, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2014; 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.