Active NPI
Abdul Rahim Tabbara
- Dentist
- Boston, MA
National Provider Identifier
1720752017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DL14964
- Practice address
- 1 Kneeland St
Boston, MA 02111 - Phone
- (617) 636-6591
- NPI assigned
- Aug 2, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | DL14964 | MA | Primary |
Addresses
Primary practice location
1 Kneeland St
Boston, MA 02111
Mailing address
460 Harrison Ave
#212
Boston, MA 02118
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 |
|---|---|---|---|
| DL14964 | MA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645574400000",
"number": "1720752017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "460 HARRISON AVE",
"address_2": "#212",
"city": "BOSTON",
"state": "MA",
"postal_code": "02118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 KNEELAND ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "02111",
"telephone_number": "617-636-6591"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TABBARA",
"first_name": "ABDUL RAHIM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-08-02",
"last_updated": "2022-02-23",
"certification_date": "2022-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DL14964",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.