Individual provider Active NPI

Matthew Stotland, DMD

  • General Practice Dentistry
  • Boston, MA
National Provider Identifier
1730741489
Registry record updated Apr 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
14900 Issued in MA
Practice address
635 Albany St
Boston, MA 02118-3550
Phone
(617) 358-8300
NPI assigned
Jul 2, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 6, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 14900 MA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

635 Albany St
Boston, MA 02118-3550

Mailing address

300 Harrison Ave Unit 225
Boston, MA 02118-2823
Phone (480) 371-7961

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230328000469 MA Order and Referring Only - DentistPractitioner - Dentist 2466824586

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14900MAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1562025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649203200000",
    "number": "1730741489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 HARRISON AVE UNIT 225",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182823",
            "telephone_number": "480-371-7961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 ALBANY ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021183550",
            "telephone_number": "617-358-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOTLAND",
        "first_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-07-02",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "14900",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.