Brock Riedel, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN1859503 Issued in MA

Practice address

862 Lexington St
Waltham, MA 02452-4849

Phone

(781) 684-9714

NPI assigned

Jun 7, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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

Practice roles

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

• Waltham Modern Dentistry, PC

  • Dentist
  • Waltham, MA
  • NPI 1528525482
  NPD (past)

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

{
    "created_epoch": "1654560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1750010542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WEST 5TH",
            "address_2": "APT 605",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02127",
            "telephone_number": "785-320-1841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "862 LEXINGTON ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024524849",
            "telephone_number": "781-684-9714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIEDEL",
        "first_name": "BROCK",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-07",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1859503",
            "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": []
}

• Eva L Richardson
• Martin Richler, M.D.
• Zoe Richman
• John C Richmond, M.D.
• Teresa Janette Ricker, LCSW
• Katherine M Riggert, D.O.
• Rising Above LLC
• Jessica Rizzo
• Christine A. Robb, MD
• Jeffrey A Roberts

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; 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.