Woburn Street Dental, PC

Primary specialty

DentistTaxonomy code 122300000X

License

21583 Issued in MA

Legal business name

WOBURN STREET DENTAL, PC

Practice address

18 Woburn St
Medford, MA 02155-3428

Phone

(781) 396-1414

Fax

(781) 396-9238

NPI assigned

Jun 23, 2013

Organization subpart

No

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

Authorized official

Name

Boris Bacanurschi, DMD

Title

Owner

Phone

(781) 396-1414

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1371945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371945600000",
    "number": "1740629724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 WOBURN ST",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553428",
            "telephone_number": "781-396-1414",
            "fax_number": "781-396-9238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 WOBURN ST",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553428",
            "telephone_number": "781-396-1414",
            "fax_number": "781-396-9238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOBURN STREET DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-23",
        "last_updated": "2013-06-23",
        "status": "A",
        "authorized_official_last_name": "BACANURSCHI",
        "authorized_official_first_name": "BORIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-396-1414",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "21583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter D Wisdom
• Julia Dennon Wise, LICSW
• Jennifer Wisniewski, OTR/L
• Mary Wisniewski, MSW
• Alan B Witkower, EDD
• Sandra L Wolosenko, L.I.C.S.W
• Tony Woo, DDS
• Melissa Wood, M.A.
• Sydney Amelia Wood
• Nancy Ann Woodfork, MSW,LICSW

• Dentist in Medford, MA
• Providers in Medford, MA by specialty
• Dentist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2013; 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.