Active NPI
Peter Alan Jezewski, DDS PHD
- Periodontics
- Chelsea, MA
National Provider Identifier
1730102088
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 21238
- Practice address
- 100 Everett Ave
Unit 5
Chelsea, MA 02150 - Phone
- (617) 884-4444
- Fax
- (617) 884-4448
- NPI assigned
- Jul 26, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 21238 | MA | Primary |
Addresses
Primary practice location
100 Everett Ave
Unit 5
Chelsea, MA 02150
Mailing address
140 The Fenway
The Forsyth Institute Room 411
Boston, MA 02115
Phone (617) 892-8491
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0204544 | Medicaid | MA |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21238 | MA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730102088",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "140 THE FENWAY",
"address_2": "THE FORSYTH INSTITUTE ROOM 411",
"city": "BOSTON",
"state": "MA",
"postal_code": "02115",
"telephone_number": "617-892-8491",
"fax_number": "617-892-8303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 EVERETT AVE",
"address_2": "UNIT 5",
"city": "CHELSEA",
"state": "MA",
"postal_code": "02150",
"telephone_number": "617-884-4444",
"fax_number": "617-884-4448"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEZEWSKI",
"first_name": "PETER",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "DDS PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MA",
"license": "21238",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0204544",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chelsea, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.