Gary Li, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DN1859006 Issued in MA

Practice address

158 Main St Ste 101
Agawam, MA 01001-1803

Phone

(413) 728-1500

NPI assigned

Jun 17, 2020

Last updated

Jul 1, 2023By 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 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

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

{
    "created_epoch": "1592352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688169600000",
    "number": "1760008668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 KEMPTON ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156271",
            "telephone_number": "617-407-0451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 MAIN ST STE 101",
            "city": "AGAWAM",
            "state": "MA",
            "postal_code": "010011803",
            "telephone_number": "413-728-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LI",
        "first_name": "GARY",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-17",
        "last_updated": "2023-07-01",
        "certification_date": "2023-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MA",
            "license": "DN1859006",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Langley
• Rodney J. Larsen, M.D.
• Cynthia Lawlor, LCSW, LICSW
• Carla James Lee, LMHC
• Lilia Levchyk, DPT
• Anne Catarine Lund, P.T
• Athena Marie M Fleury, MS, BCBA, LABA
• Samantha Machado
• Sharon Anne Macmillan, MD
• Jessica A Macwilliams, PAC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2023; 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.