Active NPI
Michael B Koidin, D.D.S., M.SC.D.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Lynn, MA
National Provider Identifier
1801871314
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 12700
- Practice address
- 77 Broad St
Lynn, MA 01902-5003 - Phone
- (781) 599-2900
- Fax
- (781) 598-1670
- NPI assigned
- Dec 8, 2005
- Last updated
- Mar 25, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 12700 | MA | Primary |
Addresses
Primary practice location
77 Broad St
Lynn, MA 01902-5003
Mailing address
PO Box 233
Swampscott, MA 01907-0333
Phone (781) 599-2900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0251771 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12700 | MA | MD | Gerontology Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DRS. Perlman & Koidin, P.C. | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
| Lynn Pediatric Dentistry and Orthodontics, LLC | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Orthodontics and Dentofacial Orthopedics Dentistry
- Lynn, MA
- NPI 1538144043
-
dba Drs. Park, Perlman & Koidin
- Pediatric Dentistry
- Lynn, MA
- NPI 1619404852
Orthodontics and Dentofacial Orthopedics
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458864000000",
"number": "1801871314",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 233",
"city": "SWAMPSCOTT",
"state": "MA",
"postal_code": "019070333",
"telephone_number": "781-599-2900",
"fax_number": "781-598-1670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "77 BROAD ST",
"city": "LYNN",
"state": "MA",
"postal_code": "019025003",
"telephone_number": "781-599-2900",
"fax_number": "781-598-1670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOIDIN",
"first_name": "MICHAEL",
"middle_name": "B",
"credential": "D.D.S., M.SC.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-08",
"last_updated": "2016-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MA",
"license": "12700",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0251771",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lynn, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.