Gabriel Boustani, D.M.D., M.S.D.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

21631 Issued in MA

Practice address

1540 Beacon St
Brookline, MA 02446-2215

Phone

(617) 738-1950

NPI assigned

Jun 25, 2006

Last updated

Jan 23, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gabriel Boustani DMD PC

  • Periodontics
  • Brookline, MA
  • NPI 1306235064
  NPD Authorized official
• Gabriel Boustani DMD PC

  • Periodontics
  • Chestnut Hill, MA
  • NPI 1396209961
  NPD Authorized official
• Boustani Periodontics PC

  • Periodontics
  • Providence, RI
  • NPI 1114745155
  NPD Authorized official

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421971200000",
    "number": "1740216084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 GREENWOOD ST",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "024593013",
            "telephone_number": "617-640-4637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 BEACON ST",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024462215",
            "telephone_number": "617-738-1950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUSTANI",
        "first_name": "GABRIEL",
        "name_prefix": "Dr.",
        "credential": "D.M.D., M.S.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-25",
        "last_updated": "2015-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MA",
            "license": "21631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Boston Vision Network One
• Bostonia Dental Group P.C (Bostonia Dental of Brookline)
• Nicole Hurley Boudreau, MD
• Bountiful Mental Health, PLLC
• Bournewood Clinical Associates
• Barbara J Bowe, MSW LICSW
• Kim Elise Bowman, MD
• Jessica Boyatt, PSY.D.
• Michael Kristopher Boyko, D.C.
• Brian W Boyle, MD

• Periodontics in Brookline, MA
• Providers in Brookline, MA by specialty
• Periodontics in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.