Active NPI
Oscar Stanton Depriest IV, D.M.D.
- General Practice Dentistry
- Bedford, MA
National Provider Identifier
1811040546
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 14565
- Practice address
- 56 Great Rd
Bedford, MA 01730-2120 - Phone
- (781) 275-7707
- Fax
- (781) 275-1443
- NPI assigned
- Jan 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 14565 | MA | Primary |
Addresses
Primary practice location
56 Great Rd
Bedford, MA 01730-2120
Mailing address
504 Springs Rd
Bedford, MA 01730-1199
Phone (781) 275-2029
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150601001550 | MA | Order and Referring Only - Other (Physician) | 2769703941 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14565 | MA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1811040546",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "504 SPRINGS RD",
"city": "BEDFORD",
"state": "MA",
"postal_code": "017301199",
"telephone_number": "781-275-2029",
"fax_number": "781-275-2881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "56 GREAT RD",
"city": "BEDFORD",
"state": "MA",
"postal_code": "017302120",
"telephone_number": "781-275-7707",
"fax_number": "781-275-1443"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEPRIEST",
"first_name": "OSCAR",
"middle_name": "STANTON",
"name_prefix": "Dr.",
"name_suffix": "IV",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "14565",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bedford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.